Best Practices for Screening and Early Treatment for HIV in the Latino Community

Introduction

The use of antiretroviral therapy (ART) has transformed HIV infection from the perception of being a terminal into a manageable chronic illness (Dominguez, 2017). Research indicates that ART plays a crucial role in reducing the viral load and the possibilities of secondary transmission. Majority of the 35 million individuals who have been diagnosed with HIV reside in resource-limited settings (RLS) (World Health Organization, 2016). As of 2016, 17 million people living with HIV (PLWH) have been receiving ART with a target of 20 million being set by the World Health Organization (WHO) by the year 2020 (WHO, 2016). Perhaps the most affected victims of HIV/AIDS pandemic are the approximately 2.2 million children under the age of 15 living with the virus. Additionally, children constitute 13 percent of new infections and account for 17 percent of annual mortalities (WHO, 2016).

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Studies indicate health disparities exists among the Latino community who are among the ethnic minorities that are adversely affected by the effects of HIV/AIDS in the United States (WHO, 2016), (CDC, 2016). Two major factors that have contributed to the prevalence of the AIDS pandemic are the reluctance to seek out testing and the barriers associated with initiation of ART. Delay in the integration of treatment creates a lasting impact in adherence in the HIV continuum.

Problem Statement

Rates for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) continue to increase in the United State among the Latino Community. According to Dominguez (2017), the most recent data by Center for Disease Control (CDC) illustrates that Latinos and Hispanics represented 24 percent of new HIV in the year 2015, yet they account for 17 percent of the total American population. Bisexuals and men who have sexual intercourse with men accounting for more than 8 out of every 10 new HIV diagnoses among Latino men. Dominguez (2017) estimates that at this rate one in four Latino gay and bisexual men will be diagnosed with HIV in their lifetime. The HIV diagnosis among Latino men is more than three times that among white men. The HIV diagnosis among Hispanic women in in 2015 was more than three times that of white women (Center for Disease Control, 2016).

Southern California has a significant Hispanic population. From 1981-2006, the population of Latinos in Southern California has been rising steadily to more than 30 percent (DOH, 2018). Accordingly, of all HIV/AIDS cases reported in the state, more than 25 percent are among the Latinos living in Southern California (Center for Disease Control, February, 2007). Twenty-one percent of new disease infections and one in five deaths due to HIV have been reported to be among Latinos (Center for Disease Control, 2016). HIV transmission patterns between whites in Southern California and Latinos vary; heterosexual transmission is the most common form of transmission in Latinos as opposed to males having sex with men in whites (Center for Disease Control, 2016). Because of the cultural stigma of homosexuality among Latino men, men are more likely to be having sex with men and women simultaneously. It is also not uncommon for Latino men to have sex with more than one woman at a time, thus increasing the risk of transmission (Center for Disease Control, February, 2007). These trends call for a cross border healthcare campaign to prevent the higher levels of transmission between the locals and immigrants.

Community Health Workers (CHW) report that Latinos in the targeted Southern California communities are slow to request testing and even slower to adopt ART, which research indicates plays a crucial role in reducing the viral load and the possibilities of secondary transmission (Center for Disease Control, February, 2007). Cultural norms and prejudices need to be considered when approaching education in this macho community, where 73% of new diagnoses among men occur among men who have sex with both men and women (Lopez-Quintero et al. 2016). The stigma associated with HIV and homosexuality may contribute to the higher rate of male to female transmission in the Latino population.

Purpose Statement

The gap in nursing practice within public health teams is the lack of knowledge of best evidence-based practices with this specific at-risk population. There have been concerns about the high infection rate of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) among Latinos and Hispanics in the United States. There have been concerns that Latinos are not diagnosing HIV at an early stage when compared to other races such as the blacks and whites. According to Lopez-Quintero et al. (2016), Latinos are more likely to delay their HIV testing till the emergence of an AIDS-defining illness.

The purpose of this quality improvement project is to do a systematic review of the literature and the outcomes of HIV/AIDS public health programs targeting the Latino population in the western United States. The profile of Latino HIV/AIDS population on the East Coast is more likely to be associated with intravenous drug use and the origins of the population are more likely to be Puerto Rican than Mexican and Central American that populate the Southwest (Lopez-Quintero et al. 2016). This systematic review will be presented to public health and community health workers to better inform them about ways to improve success in out-reach and intervention to this population.

Practice - Focused Question

The practice-focused question is "what are the successful programs of HIV/AIDS public health intervention that can inform community workers on best practice for the California Latino population?"

Social Change

The significant social change is instituting preventive interventions for HIV/AIDS founded on the paradigm shift that exclusively focuses on target populations to a community engagement model. In essence, this implies that focus has shifted from individuals to incorporate a comprehensive strategy where social and structural modules are essential. Patients who can overcome personal barriers such as being in denial may also be subjected to a wide range of extensive community barriers such as poverty, stigma, and challenges in navigating through healthcare environment (Kippax & Stephenson, 2014).

Context for the Doctoral Project

This literature review will be conducted from home in Southern California near the US-Mexico border. The review will also look at the information on the programs that may be reported in professional meetings or on websites that have not been published in professional journals. I will also reach out to program directors at the CDC for leads on additional projects that may be funded.

Sources of Evidence

Online databases including NIH and PubMed may be used as the primary sources of research information while books and peer-reviewed journals obtained from Google scholar comprise of the secondary sources of information. The research will also look to data from community health intervention programs that may not have published in the research literature but serve as programs, which can be analyzed for best practices, such as the Southern California Border HIV/AIDS program (Scolari, 2006).Approach or Procedural Steps

The procedural steps will involve a systematic review of the literature and publicly available websites and databases. In a systematic review, the first step involves identifying the research question, which is finding the best practices that can be implemented in nursing to encourage Latinos to regularly get HIV screening as well as early treatment. A review protocol will then be created and that involves the production of a review protocol template which discusses the key attributes of the research. Aspects such as conceptual discussion of the problem, review questions, search strategy, the criteria of including and excluding studies, the procedure of extracting data, data synthesis procedure and record keeping will be incorporated in that protocol. For this study, the problem revolves on the need to encourage Latinos in the Southwestern United States to get screened for HIV regularly in order to reduce the huge infection rate and for early treatment in order to reduce the probability of death due to AIDS-related illnesses. Studies on HIV infections, treatment, and healthcare among Latinos will be included while studies on HIV infection for studies conducted outside the United States will be excluded. Data will be extracted from the available sources and it will be used to deduce the best ways to encourage early screening and treatment among the Latino population. The next step includes conducting a thorough Literature review for sources that identify what past studies have identified on this topic. In a systematic review, sources are very vital as a source of evidence and thus, a thorough such is vital in order to ensure all aspects of the topic under study are clearly evaluated.

A search on online databases, journals, and websites of public health programs can provide adequate sources for this study. The studies will then be selected and appraised based on the set protocol. This will enable ease of disagreements between different studies and also the assessment of the bias that could be exhibited by the authors of the studies. From then, the data will be extracted, analyzed and interpreted in an effort to summarize evidence that can be utilized in practice to improve healthcare. The final step is to analyze the data to ensure that the research question is answered according to the instrumentation plan.

Ethical Issues

I will only be researching the public websites and literature so there is no risk to human rights. Research studies regarding the transmission and prevalence of HIV touches on moral and ethical issues about the dignity of the participants. Given the effects and the stigma associated with the disease, in most studies there is a need to establish a proper framework to protect the patients and their confidentiality. In this case, the study aims at improving HIV screening and adoption to ART. The information obtained will not be used for any other purpose

Alignment

Rates for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) continue to increase in the United State among the Latino Community. Particularly, in Southern California and along the US-Mexican border, the prevalence rates for the disease have continued to rise. Given that the ART medications have helped in reducing the effects of the disease and increasing lifespan for the patients, there is a need to enhance screening and adoption of ART among the Latino population. This addresses the gap in nursing practice in which patients are being treated with terminal complications that could be avoided. There is a need for primary intervention to prevent further spread and admission to the wards due to preventable complications. Replication of successful programs may help in reducing the prevalence of the disease among the Latinos and promotes ART treatment for the patients at risk.

References

California Department of Health. (2018, March 8) Office of AIDS. Retrieved from: https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OAwelcome.aspx#

Center for disease control. (2007, February 2). CDC Fact Sheet: HIV Latino male. Retrieved from: https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/Cdc-hiv- latinos-508.pdf.

Center for disease control. (2016) New HIV Diagnoses in the United States for the Most-Affected Subpopulations. Retrieved from: https://www.cdc.gov/hiv/basics/statistics.html

Chen, N. E., Gallant, J. E., & Page, K. R. (2012). A systematic review of...