Evidence-Based Practice Guideline for Management of People Living With HIV

Evidence-BasedPractice Guideline for Management of People Living With HIV

Evidence-basedpractice (EBP) guidelines for managing individuals that have alreadybeen infected with HIV were laid down and strategized by a panel ofexperts from an association that deal with infectious diseases in theU.S.A-Medicine Association of the Infectious Disease Society. Thelatest 2013 update of these guidelines replaced those put out in2009. Theguidelines are envisioned to be used by the nurses attending topatients infected with HIV (Aberg, Gallant, Ghanem, Emmanuel,Zingman&ampHorberg, 2013).There have been new antiretroviral drugs as well as the availabilityof new classes since 2009, and prognosis of the people infected withHIV has continued to improve. However, even with increased survivaland fewer complications, persons infected with HIV are progressivelycontracting common conditions that affect the overall populace aswell. A number of these problems can be connected to the infection ortreatment of HIV. Persons sick with HIV need to be managed as well asmonitored for any and all sex and age specific health conditions.

Itis now more than three decades since the first AIDS case wasreported. Dramatic changes have been realized over time in thiscourse of managing the infection (Polit&amp Beck, 2008). Also,there’s been noteworthy drop in mortality and morbidity amongstpeople having this infection, which has resulted from enhanced andeasy access to health care, antiretroviral therapy (ART), preventivetreatment against the infections that tend to be opportunistic, aswell as preventive medicine interventions. The association chose agroup of clinical technicians and working clinicians to developvarious guidelines and rules concerning the chief health care ofthose living with this infection. Since there has been increasedsurvival rate for such patients, it is vital that apart from thescreening for illnesses connected to the HIV infection and managementof infected individuals these people should as well receive otherpreventive health interventions that are recommended and basing ontheir sex and age.

Practiceguidelines or rules refer to declarations that are developed in asystematic and scientifically manner to help both patients and nursesto make good choices about suitable health care for situations thatarise in clinical environment. Respectable guidelines have attributessuch as validity, documentation, reliability, review of evidence,reproducibility, multi-disciplinary process, clinical applicability,clarity and clinical flexibility.

Thereare extensive guidelines endorsed by health services andorganizations in the United States (Aberg et al, 2013). This paperspecifically centers on one of these guidelines, which seeks toaddress the clinical question: what initial evaluation as well asinstant follow up should be taken on patients that have alreadycontracted the HIV infection. The recommendation or guideline putforward by the association that deal with the infection in the UnitedStates is:

Acomprehensive and detailed past and present history on medical field,review of systems, medication, family, social history, and physicalexamination, encompassing information related to HIV, ought to beobtained from every patient upon the initiation of care.

Howprofessionals are held by this guideline

Healthcare professionals are held by this evidence based practice guidelinein several ways. Firstly, it is important that a detailed past andpresent history, physical examination, and family of the patient beobtained from every patient after the care is provided to enablenurses deliver effective care (Albright, Haas &amp Pugh, 2014).While not every health care professional needs to be a researcher, itis crucial that every nurse uses research to monitor effectiveness,ensure safety and inform practice. This guideline requires theprofessional nurse to constantly question and justify his actions aswell as the actions of others so as to provide patients with choicesand be able to offer the most appropriate and effective carepossible. Witha known comprehensive medical history, there’s a clear rationalefor health care choices of a nurse, and he can demonstrate theevidence that informed his decisions.

Nurses,have a professional responsibility of practicing evidence based careso as empower the individual profession by use of knowledge.They should observe quality and professional accountability in theirduties. In addition, there exists a moral obligation holdingpractitioners of the health care realm especially nurses accountableto the rest of the society for the care which they deliver. Personsliving with HIV infection are vulnerable to other diseases andlargely depend on and trust the ones with expert knowledge inadvocating on their behalf by delivering the best possible care andpharmacists, nurses and doctors can only give the best care if theyknow what is best. A physical examination, review of systems, andunderstanding a patient’s medical, social and family history wouldgo a long way in helping nurses investigate to determine what isbest.

Pharmacistsare required to be professional in their field by being diligent andobserving due care so that ethical behaviors will be observed.Appropriate prescriptions should be administered to avoid under dozeor over doze to the patients as this will result to serious medicaleffects on the patients and they can be held liable by theprofessional practicing and face punishments over professionalnegligence. The pharmacist should make sure that she is competent inthe kind of prescription made to the patient.

Techniciansare professionally mandated to safeguard each patient from harm aswell as minimize risk. When health care is practiced without up tothe minute knowledge, it becomes risky and threatens patient’ssafety. It is easy to argue that thoughtless care amounts to(unintentional) abuse since the vulnerability of the patient isincreased. While a huge number of professionals potential effects ofemotional and physical harm by careless omissions or acts, many ofthem still do not sufficiently consider the harm resulting from alack of patient’s medication history and applied evidence.Technicians should also do their best to address emergency cases andalso do proper handling and safekeeping of private and confidentialinformation.

Thisevidence based practice guideline can be followed to meet aprofessional’s job criteria and fulfill his role. The guideline isnow being included in job descriptions. It is as well included inadvancement gateways like the Knowledge and Skills Framework thatidentifies the key skills and knowledge required for job postings aswell as guides for individual development. This guideline is part ofthe latest 2013 practice-evidence based- (EBP) rules for managingpeople living with the infection (HIV) and health care professionalsespecially nurses have a moral and professional responsibility tokeep abreast with developments in their professional practice.

Referenceused by the system to adopt the guideline

Theexpert panel put together by the association that deal with HIVpatients to come up with the 2013 rules and guidelines for managingpeople living with the infection (HIV) comprised of specialists ininfectious diseases, pediatrics and internal medicine (Albright, Haas&amp Pugh, 2014). The panel looked at the way different expertshandled the HIV patients and also did a survey on the patientsthemselves which was aimed at finding out how the patients werehandled by the health experts. This formed the basis of the expertpanel of developing the guidelines.

Literaturereview &amp analysis

Thepanel of experts completed the review as well as literature analysison managing people with the infection published from the year 2009.It also reviewed and analyzed older literature. They performeddigital literature searches on articles published between December2008 and July 2013. Any other date that was published after July 2013was as well used in the final preparation of the rules andguidelines. Field research was also done by visiting the patients indifferent hospitals and collecting information from them regardinghow they were treated by nurses. The research only referred toliterature available in the English language.


Membersof the panel came together on several instances through emailcommunications and teleconferencing to accomplish work on theguidelines. Teleconferences were used for the members to deliberateon the questions to be tackled, discuss recommendations and makewriting assignments. Those who participated in the panel took placein the reviewing process as well as in the draft guidelines’preparation. Additionally, the panel’s expert got feedback from theoutside peer reviewers. This was done through face to face withdifferent people who had an idea, or had witnessed the way thevictims were treated. The IDSA, the boards of HIVMA as well as theIDSA SPGC reviewed as well as cleared the guidelines beforedissemination.

Definingthe evidence used to define the guideline

Presentillness’ history

Itis important that care givers ask about dates of diagnosis of theinfection and, when possible, the approximated date that theinfection occurred. Approximated date of infection can be determinedby looking on negative results in tests conducted earlier, incidenceof symptoms suggesting infection (acute retroviral), as well as thetiming of actions that involve high risks. It is crucial to get adetailed and comprehensive patients’ medication history on thosewho have already undergone antiretroviral therapy. This can be donepreferably by reviewing all the relevant medical records (Aberget al, 2013). Thismedication history should comprise of highest viral overload, cellcount, Combinations of drug taken, any response to regimens such asviral overload and CD4 cell count, reasons for changes in treatment,duration of treatment, drug toxicities, prior drug resistance resultsand barriers to adherence when applicable. While taking acomprehensive history, the care giver can start to evaluate patient’sawareness level regarding infection and treatment of HIV, evaluationof patient’s educational needs, as well as determination of whatsocial and ancillary supports may be required.

Medicaland Past surgical history

Providersshould ask patients about any complication and comorbiditiesassociated with HIV, including OIs (opportunistic infections),malignances as well as other conditions connected to HIV. Providersought to inquire about any surgery procedure and chronic medicalconditions like gastrointestinal disease, peripheral neuropathy,hyperlipidemia, cardiovascular disease and risk, diabetes mellitus,chronic viral hepatitis, or kidney disease which may impact on theselection of therapy as well as response to the same(Lewis, Dirksen, Heitkemper&amp Bucher, 2014). Care givers should as well ask about prior mental illness history,like anxiety conditions, hospitalization history, violent behavior,bipolar disorder, and depression, as a result of mental healthdisorders. Other medical conditions experienced in the past which mayimpact on HIV infected patients comprise of shingles or chickenpoxhistory, tuberculosis and its exposure, diseases that are sexuallytransmitted, gynecological problems, and abnormal anal.

Allergiesand medications

Caregivers should be aware of patients’ medications, including drugsand prescriptions given over the counter, methadone, as well asherbal or dietary food supplements. Some of these supplements have ahigh likelihood of interacting with antiretroviral drugs. Doctors andnurses should ask patients whether they have used ARVs in post orpre-exposure prophylaxis. They should also inquire of the durationthe patients have used the drugs and if there was any problems theyexperienced as a result of using the drugs. Discussions regardingintolerances and allergies should incorporate various questions onreactions that are hypersensitive to ARVs and antibiotics (Aberget al, 2013).

Familyand social histories

Medicalhistory of any family is now more vital because persons infected withHIV have a longer lifespan they are more vulnerable to sex and agespecific complications in addition to the infection treatment relatedconditions. Health care giver should ask about patient’s familyhistory of complications which may predispose them to neurologicaldiseases, malignances, osteoporosis, as well as atheroscleroticdiseases like diabetes mellitus, hyperlipidemia and hypertension Liu,Hessol, Vittinghoff, Amico, Kroboth, Fuchs &ampBuchbinder, 2014).

Patient’ssocial history ought to incorporate discussion on the misuse ofalcohol, tobacco, and other illicit drugs. Specific questions to thepatients should include whether they abuse prescription drugs andsubstances like erectile dysfunction drugs and poppers which aremainly used with sex. It is important that patients who useinjection drugs be questioned on any drug that they use, habits,needles’ source, and if there is any sharing of these needlesamong them. They should also be questioned on any other unethicalactions they made which would have led to transmission of theinfection.


Systems’review ought to be exhaustive and incorporate questions aboutsymptoms that are related to the infection like fever, weight loss,headaches, sweating at night, ulceration or oral thrush, visualchanges, respiratory symptoms, swallowing difficulties, pain in thechest, abdominal pain, nausea, vomiting, nausea, symptoms ofinfection in the urinary, diarrhea, lesions or rashes on the skin,changes in mental status or neurological function, and anogenitalsymptoms. Patients should be requested to inform on how their weightvaries with the baseline, together with any assessment on dietary.Providers should obtain a women’s menstrual history. Any otherinformation considered basic should be asked and the victims berequested to answer diligently.

Domesticviolence screening and depression

Depressionis common with patients that have HIV. Systems’ review ought toincorporate questioning focused on changes experienced on libido,mood, and appetite, sleeping patterns, memory and concentration. Ininitial evaluation as well as periodic evaluation that follow, caregivers should assess incidence of posttraumatic conditions of stress,domestic violence, and depression by asking questions that are directand screening tools that are valid (Liu et al, 2014). Physical andadult sexual abuse ranks high in women living with HIV infection.Depression prevalence among HIV infected persons is double as much inwomen compared to men. It is more pronounced when there isvictimization or violence. Any other effect observed should berecorded.

Levelof evidence

Theexpert panel followed the procedure applied in the advance of otherInfectious Society’s rules and guidelines in evaluating variousform of evidence on the management of people living with theinfection. The panel made use of the method of GRADE in determiningthe quality of any evidence provided and the strong points of eachrecommendation in the set of guidelines (Lewis et al, 2014). GRADEstands for Grades of Recommendation, Assessment, Development andEvaluation. The guideline of a detailed past and present history ofmedication, given medication, family, systems’ review, socialhistory, and physical examination, encompassing information relatedto HIV, need to be obtained from every patient upon the start ofhealth care has a quality that is moderate as further research wouldprobable result into a significant effect on the confidencepractitioners have in the estimated impact and the estimate may bechanged. This is characterized by one high quality study and severalother studies with limitations. The guideline is a strongrecommendation with consistent, good quality and patient orientedevidence that has been shown to help HIV infected patients to livebetter and longer lives, including improved quality of life, symptomimprovement, lowered cost, reduced mortality and reduced morbidity.

Caregivers have done well to follow the guideline

Whilestopping the spread of HIV is paramount to the control of acquiredimmune deficiency syndrome (AIDs), epidemic, health workers must aswell care for the tens of millions of people already living with theinfection. With a lack of cure and accessible treatment for reducingdamage on the immune system, provision of care usually meansassisting persons living with HIV or AIDs cope up with the social,physical and psychological burdens of the chronic and eventuallyterminal disease.

Inindustrialized nations, up to ten years elapse between HIV infectionand development of clinical AIDs. Infected persons can survivebetween one and five years after this without antiretroviraltreatment. Developing countries have shorter survival times due toco-infections with other complications, malnutrition, and moreinadequate access to proper health care.

Ibelieve that professionals caring for and managing persons livingwith HIV infection have done commendably well in following thisguideline requiring them to obtain adetailed past and present systems’ reviews, history on medication,medication given, family, social history, and physical examination,comprising of HIV related information, from every patient upon theinitiation of care. The early counseling provided as soon asdiagnosis of HIV is made helps patients cope with the situation, andpatients benefit from advice to avert future health complications.The taking of patients’ medical history and HIV related informationhas gone a long way to increasing quality of life and in most casesprolonging the life of persons with HIV/AIDs. The healthprofessionals have followed the guidelines to the latter because theyknow that without doing so they will be accused and held liable forprofessional negligence.


Astreatment of HIV infection has continued to lower mortality and atthe same time increase the number of patients who are clinicallystable, the primary care methodology to HIV infected persons hasevolved. The association that deal with HIV patients recommends thatthe management of these patients should always start with acomprehensive past and present systems’ reviews, medication given,family, social history, and physical examination, encompassinginformation related to HIV, being obtained from every patient uponthe initiation of care.

Thisguideline holds nurses, doctors and pharmacists morally andprofessionally responsible to deliver the best care possible to HIVinfected persons. Itis an evidence based guideline that makes practitioners to use safeand effective methods in safeguarding and minimizing risk on everypatient. It also allows professionals to fulfill their role and meetjob criteria. The guideline was recommended by a panel of expertsmandated by the associations that deal with HIV patients to come upwith the 2013 EBP rules and guidelines for managing people livingwith the infection and is ranked as a strong recommendation withmoderate evidence. The guideline was developed free of bias takingcare of the concerns of medical professions and the patients. It hashelped deal with controversies which arise between the two parties.


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