Fusing HIV Prevention into the Medical Care of Persons Living with HIV

2533 days ago, 925 views
PowerPoint PPT Presentation
Joining HIV Avoidance into the Therapeutic Consideration of Persons Living with HIV. Ask Screen Mediate. Expert Work Bunch Individuals. John Bartlett, MD

Presentation Transcript

Slide 1

Joining HIV Prevention into the Medical Care of Persons Living with HIV Ask Screen Intervene

Slide 2

Consultant Work Group Members John Bartlett, MD – Johns Hopkins University School of Medicine Wayne Bockmon, MD – Montrose Clinic John T. Creeks, MD – Centers for Disease Control and Prevention Kevin Carmichael, MD – El Rio Special Immunology Associates Alwyn Cohall, MD – Mailman School of Public Health Eric Daar, MD – Harbor-UCLA Medical Center

Slide 3

Consultant Work Group Members David Hardy, MD – Cedars-Sinai Medical Center Peter Meacher, MD – South Bronx Health Center for Children and Families, Montefiore Medical Center Evelyn Quinlivan, MD – University of North Carolina, Chapel Hill Peter Shalit, MD – Swedish Medical Center Mark Thrun, MD – Denver STD/HIV Prevention and Training Center

Slide 4

John T. Creeks, MD Leader, Clinical Epidemiology Team Division of HIV/AIDS Prevention NCHSTP, CDC Atlanta VA Medical Center Atlanta, GA

Slide 5

Alwyn T. Cohall, MD Associate Professor, Clinical Public Health and Pediatrics, Columbia University Director, Harlem Health Promotion Center New York, NY

Slide 6

Keith Rhoades Mental Health Specialist HIV-Positive for 4 Years Torrance, CA

Slide 7

Incorporating HIV Prevention into the Medical Care of Persons Living with HIV Ask Screen Intervene

Slide 8

Prevention in Care Recommendations Developed by CDC, HRSA, NIH, HIVMA, with proof based approach Apply to therapeutic care of all HIV-contaminated young people and grown-ups Intended for those giving medicinal care to HIV-constructive people

Slide 9

Background: Advancing HIV Prevention (AHP) Rationale for AHP essential objective: decrease HIV transmission AHP's 4 need procedures Recommendations address system 3

Slide 10

Rationale for Recommendations AHP: with treatment, more Americans are living with HIV and AIDS. Each transmission originates from a HIV-constructive individual. Recently analyzed patients have a tendency to alter conduct to counteract transmission—yet regularly backslide. Suppliers: interesting chance to impact counteractive action practices of HIV-positive patients amid restorative visits.

Slide 11

The Potential Impact of Healthcare Providers Many HIV mind suppliers don't get some information about continuous HIV transmission hazard. This is a missed open door. Confide in Provider validity

Slide 12

What's Stopping Us? Duty Time Privacy Comfort Level Skills Scope Resources Impact Reimbursement Beliefs/observations

Slide 13

Prevention in Care: The Basic Steps Ask Brief evaluation of HIV transmission chance practices Screen Identify and treat different STDs Intervene Deliver brief anticipation messages Address misguided judgments Make an arrangement: select an initial step or potentially allude

Slide 14

How to Ask

Slide 15

Ask: Brief Assessment of HIV Transmission Risk Behaviors Definition of brief appraisal for behavioral hazard elements Pointers Be prudent and deferential Be clear, evade restorative language Be non-judgmental Use both open-and shut finished inquiries Use consent giving proclamations

Slide 16

Tools Available to Start Risk Assessment Conversations

Slide 17

How to Screen

Slide 18

Screen: Identify and Treat Other STDs Diagnostic testing versus screening Who do you screen? Everybody one time for each year Everyone who reveals hazard conduct

Slide 19

Screen: Focus on Hepatitis C 1 One-fourth of HIV-constructive patients are additionally tainted with Hepatitis C (HCV) 50-90% of individuals contaminated with HIV through intravenous medication utilize (IDU) have HCV 75%-85% of HCV diseases turned out to be incessant HIV-HCV co-disease has been related with: Higher titers of HCV More quick movement to HCV-related liver illness An expanded hazard for HCV-related cirrhosis of the liver Guidelines prescribe all HIV-contaminated people are screened for HCV contamination CDC FAQs About Co-disease with Hepatitis C Virus http://www.cdc.gov/hiv/assets/qa/HIV-HCV_Coinfection.htm

Slide 20

How to Intervene

Slide 21

Intervene: Communicate Prevention Messages Frequency Every patient, each visit Three primary parts Address misguided judgments Deliver aversion messages Make an arrangement: select an initial step as well as allude

Slide 22

Intervene: Deliver Brief, Tailored Prevention Messages Definition of counteractive action message Prevention messages custom fitted to patients-cases STDs encourage transmission of HIV There is a danger of superinfection Injection tranquilize utilize builds chance You can even now transmit HIV regardless of ART, PEP Low popular load does not mean you can't transmit HIV

Slide 23

Intervene: Deliver Brief, Tailored Prevention Messages Brief, custom-made anticipation messages What are they? How would they function with patient instruction? Why are they successful? Marx, et al research Can prompt to initial steps

Slide 24

Address Common Misconceptions: Risk of Acquiring HIV Based on Specific Sexual Behaviors

Slide 25

Intervene: Identify Misconceptions Sample Questions What do you think about how individuals get STDs? What do you think about how individuals get HIV? What are your worries about offering HIV to another person? What are your worries about getting a STD or hepatitis?

Slide 26

Intervene: Make a Plan Behavior change is a procedure, not an occasion. To roll out an arrangement for improvement, offer alternatives and talk about these with your patient to locate an initial step: Referrals might be an initial step Help make a go down arrangement

Slide 27

Intervene: On-going Prevention at Every Visit Ask understanding about advance If patient is not venturing out the objective: Positive support Anticipate new issues or changes (Ask "imagine a scenario where .. . .?" questions) Identify next strides

Slide 28

Intervene: On-going Prevention at Every Visit Ask persistent about advance If patient is not venturing out: more inquiries regarding conditions, demeanors, availability Revise initial step Consider referrals

Slide 29

Intervene: Referral Resources Referrals to: Behavioral intercessions Individual, assemble, group Referrals to different administrations Patient training materials accessible in your office HIV Comprehensive Risk-Reduction Counseling and Services (CRCS) Providers of Services

Slide 30

HIV Comprehensive Risk-Reduction Counseling and Services (CRCS) Voluntary and secret administration Assists people living with HIV to tell their partner(s) about conceivable introduction Provides access to testing and other counteractive action administrations

Slide 31

Screen: Physician-Patient Communication Key to Overall Outcomes Ensure the workplace staff and culture are not unfair Display visuals and writing touchy to sexual assorted qualities Provide non-scaring medicinal writing Use comprehensive dialect in admission structures Be mindful of verbal and non-verbal communication Be open and non-judgmental Show ability to listen Be delicate to classification concerns Remember: It just takes a couple of more minutes to persuade your patients 85% of patients don't completely comprehend what the specialist lets them know OVER half of patients leave the workplace uncertain of what they should do Source: Kaplan SH, et al. Med Care. 27(3 Suppl):S110-S127.

Slide 32

Conclusions Ask, Screen, Intervene Brief appraisal and message(s) Every patient, each visit Unique open door

Slide 33

Prevention IS Care Resources The Prevention IS Care Provider Resource Kit contains materials and assets to guide you with counteractive action messages Physician Intervention Tools Patient Education Materials Available in English and Spanish For more data: www.cdc.gov/PreventionISCare

Slide 34

Additional Resources Local Health Department HIV/AIDS Programs – http://www.cdc.gov/nchstp/dstd/Public_Health_dept.htm National Alliance of State and Territorial AIDS Directors (NASTAD) – www.nastad.org Advancing HIV Prevention: Interim Technical Guidance for HIV Partner Counseling and Referral Services (Centers for Disease Control and Prevention) www.cdc.gov/hiv/accomplices/Interim/partnercounsel.htm State STD Program Managers

Slide 35

Additional Resources National Coalition of STD Directors – www.ncsddc.org HIV Criminal Law and Policy Project - www.hivcriminallaw.org National Network of STD/HIV Prevention Training Centers – Partner Management and Program Support Services Training – www.nnptc.org

Slide 36

Patient Perspective Keith Rhoades HIV-Positive for 4 Years Torrance, CA

Slide 37

My HIV Diagnosis Experience Initial side effects Request for a HIV Test Physician conveyance of determination Search for new doctor x2

Slide 38

Evolution of Relationship 1 st Visit: Awkward to talk about sex, dread of judgment 2 nd Visit: Comfort expands, more open exchange 3 rd Visit: Trust being constructed, start legitimate discussion, prepared to tune in to avoidance messages

Slide 39

Today: During Every Visit Medication Prevention messages Overall wellbeing Keeping me solid in ALL parts of my life ~ Constant updates

Slide 40

Effective Messages HIV is not a capital punishment Decrease tension of introductory stun Increase any desire for a more extended life Develop a feeling of reasonability Focus swings to long haul wellbeing and aversion transmission practices – keeping self as well as other people sound

Slide 41

Effective Messages Every visit guarantees we… Maintain comfort level Maintain a non-judgmental condition Maintain transparent discourse; improving probability of unveiling dangerous conduct Because of his approach, I tune in and act

Slide 42

Effective Messages Providing Informational Resources Creates comfort for patient to examine in private Gives trust about new research and prescription Decreases nervousness between visits Keeps me concentrated on keeping me sound

Slide 43

Final Thoughts Building connections requires some serious energy Consistency is enter in changing conduct Realize your words do make a difference