Reducing HIV Transmission in Primary Care

Introduction

HIV remains a huge public health concern with millions of individuals infected with the virus globally. Since they are frequently patients’ initial point of contact with the healthcare system, primary care doctors play a crucial role in HIV prevention and management. This plan presents a comprehensive approach to reducing the risk of HIV transmission in primary care settings. The strategy incorporates routine HIV testing for everyone, regardless of risk factors, and pre-exposure prophylaxis (PrEP) for those at high risk of contracting HIV. The proposed plan to reduce HIV transmission in primary care settings may be incorporated with the Healthy People 2030 goals for illness and health prevention. Several nationally agreed-upon goals for enhancing the health of all Americans during the next ten years are outlined in the Healthy People 2030 initiative. Health equality, access to treatment, and the socioeconomic determinants of health are highlighted in Healthy People 2030 as the top priority for illness and injury prevention (Healthy People 2030, 2023). Primary care clinicians can implement this strategy to help prevent new HIV infections and ensure that individuals with HIV get the treatment they need to continue living normally.

Problem

Although improvements in medical care have significantly enhanced the health of those with HIV, the most effective method for managing the epidemic is prevention. This is because there is presently no treatment for HIV. Antiretroviral therapy (ART) is a lifetime medication that may suppress the virus, but it also has potential negative effects. Additionally, there are still many regions of the globe where access to ART is restricted, especially in countries with low or middle incomes where a majority of new infections occur.

Therefore, HIV prevention programs are essential for lowering new infections and decreasing the virus’s spread. The use of condoms, PrEP, elective medical male circumcision, harm reduction for injecting drug users, HIV testing, and counseling are examples of prevention techniques. The risk of HIV transmission is decreased by these treatments, but there are still large gaps in access and uptake, especially among critical groups including sex workers, drug injectors, and men who have sex with males (Kabapy et al., 2020). Achieving the worldwide goal of eradicating the HIV pandemic by 2030 would require addressing these gaps and stepping up preventive measures.

Objectives

The fundamental goal of this primary care strategy is to:

1. Raise patient and primary care provider knowledge of HIV prevention.
2. Make HIV testing, PrEP, and post-exposure prophylaxis (PEP) service more widely available.
3. Strengthen care connections for those who test positive for HIV.
4. Increase the use of electronic health records (EHRs) to help manage and prevent HIV

Population Identification

This plan is intended to benefit those who seek primary care services, with a particular emphasis on those at a greater risk of contracting HIV. This encompasses people who practice high-risk sexual behavior, substance injectors, and those with an HIV-positive partner. The proposal recognizes that these populations encounter major obstacles to healthcare access, such as discrimination and stigma. The initiative endeavors to enhance the health outcomes of these groups by providing early detection and treatment of HIV through the provision of targeted primary care services. In addition, it emphasizes the significance of care that is culturally competent and sensitive, which aligns with Healthy People 2030’s focus on health equity (Healthy People 2030, 2023). Healthcare providers must be trained to provide care that is sensitive to the cultural, linguistic, and social backgrounds of the diverse populations they serve.

Project Question

How can primary care providers play a more effective role in preventing HIV transmission?

Description Of the Proposed Solution

The proposed solution is an all-encompassing strategy that makes use of teaching, diagnostics, care, and EHR interventions. Access to care is a priority for Healthy People 2030, and these initiatives support that goal (Healthy People 2030, 2023). The Healthy People 2030 goal of increasing the percentage of individuals who get preventative treatments are aligned with routine HIV testing for all patients, regardless of risk factors.

Education

Primary care clinicians will be educated on new methods of HIV prevention including PrEP and PEP. Knowledge of HIV, its transmission, and the availability of PrEP and PEP will be disseminated to patients. Furthermore, education will provide patients and healthcare practitioners with the information and skills essential for managing HIV-related diseases efficiently. This involves teaching patients about preventative measures, lifestyle changes, and self-care practices that may aid in their overall health.

Testing

Testing is an important aspect of the solution, as it can help detect HIV in its early stages when they are most treatable. In compliance with CDC recommendations, primary care practitioners will conduct regular HIV testing on all patients aged 13 to 64 years. Individuals who participate in high-risk activities or have an HIV-positive partner will also be offered targeted testing. To correctly diagnose health issues, several diagnostic tools and procedures will be used throughout testing.

Treatment

Another important component of the proposed approach is treatment, which entails providing patients with proper medical care and measures to manage their health issues. Those who test positive for HIV will be placed on treatment immediately, including ART and other supporting services. Individuals at high risk of HIV transmission will also be offered PrEP and PEP by primary care practitioners. Healthcare professionals can help to optimize health outcomes and minimize HIV transmission by providing patients with access to appropriate treatment and interventions.

EHR-Based Interventions

The adoption of EHRs will assist in HIV management and preventive efforts. EHR-based interventions are a key element of the proposed approach because they give healthcare practitioners real-time visibility of patient data and allow them to make informed decisions about patient care. This includes identifying individuals who are scheduled for HIV testing, giving recommendations for PrEP and PEP, and monitoring patients’ adherence to ART. EHR-based interventions can enhance care coordination and communication among clinicians, leading to improved patient health outcomes. Implementation of EHRs for HIV management and prevention is consistent with the Healthy People 2030 goal of expanding the use of health information technology to enhance the public’s health and healthcare quality.

Literature Supporting the Project Plan

The CDC and other public health organizations’ recommendations are supported by evidence and form the basis of the recommended solution. Regular HIV testing, together with PrEP and PEP, has been demonstrated to drastically lower HIV transmission rates (The Centers for Disease Control and Prevention, 2023). It has also been established that EHR-based treatments enhance HIV care outcomes. The CDC advises PrEP as a method of HIV prevention noting that using PrEP medicine as advised decreases the risk of contracting HIV through sex by 99% and among drug injectors by at least 74% (CDC, 2023). These evidence-based recommendations and best practices are effective HIV transmission rate reduction strategies.

Similarly, research supports the use of HIV testing, PrEP, PEP, and EHR-based interventions to reduce HIV transmission rates. For example, a systematic literature review, for instance, examined the use of HIV self-testing (HIVST) to encourage PrEP distribution and determined that HIVST use for PrEP continuation had similar outcomes to standard-of-care delivery and was viewed to be suitable and effective (Kiptinness et al., 2022). In a different research, homosexual men who are HIV-negative and on PrEP showed increased PrEP adherence after receiving weekly bidirectional support messages over 12 weeks (Fuchs et al., 2018). These studies show how diverse treatments may lower HIV transmission rates and enhance outcomes for those who are at risk.

The Theory of Change to Be Used

The Health Belief Model (HBM) serves as the project’s theory of change. According to the HBM, people are more inclined to act to avoid an illness if they feel at risk and are confident that the suggested measures would be successful. Perceived vulnerability, perceived severity, perceived benefits, and perceived obstacles are the four main factors identified by the HBM as having an impact on an individual’s health behavior (Sulat et al., 2018). The term perceived susceptibility refers to a person’s perception that they are susceptible to getting an illness. The term perceived severity describes how seriously a person believes they might be affected by a sickness. A person’s perception of the advantages of taking preventative action is referred to as their perceived benefits, while their perception of the hurdles to action is referred to as their perceived barriers (Sulat et al., 2018). The HBM may serve as a theoretical framework to guide the creation of treatments and programs meant to encourage healthy behavior.

The HBM can be used to develop strategies that raise people’s understanding of their vulnerability to HIV, the severity of the illness, the advantages of preventive measures, and methods to get around obstacles to prevention in the framework of the HIV prevention strategy. By targeting these issues, the HBM could help individuals feel more motivated and confident to take steps to avoid HIV, improving both individual and community health outcomes.

Implementation of the Plan

Assessment

The implementation of the plan will be evaluated based on the following criteria:

• The number of primary care physicians who have received HIV prevention training.
• The number of patients receiving HIV testing, PrEP, and PEP services.
• The number of HIV-positive patients who are connected to care.
• The utilization of EHR-based interventions to promote HIV prevention and management

Diagnostic

Ongoing data collection will help pinpoint where the strategy is falling short of its goals. Patient feedback will be the key procedure for this task. Feedback from patients on the effectiveness of the HIV prevention services they received, including their interactions with physicians and ease of access to services, will be gathered by the staff. The responses will provide insight into areas that should be improved, for example, patient education or PrEP accessibility.

Outcomes

The expected outcomes of this plan are:

• Increased HIV prevention strategy awareness among primary care physicians and patients.
• Access to HIV testing, PrEP, and PEP services is enhanced.
• Increased connection to care for HIV-positive individuals.
• Improved use of EHRs for HIV prevention and management

Implementation

The following steps will be taken to implement the plan:

• Create educational resources on HIV prevention techniques, including PrEP and PEP, for health care providers and patients.
• Educate medical personnel on methods for preventing HIV and the use of interventions based on EHRs.
• Include HIV testing in routine primary care services.
• Provide HIV testing for people who participate in high-risk behaviors or have an HIV-positive partner.
• Provide PrEP and PEP services to high-risk individuals for HIV transmission.
• Provide HIV-positive individuals with access to care immediately.
• Employ interventions based on electronic health records to support HIV prevention and management

Evaluation

The plan will be continuously assessed using the tools described in the assessment section. Collecting and analyzing data will reveal where the plan is falling short, allowing for amendments to be made. Specifically, medical staff will be encouraged to frequently monitor HIV-positive patients’ adherence to antiretroviral therapy, in addition to their viral load and CD4 count. This will help to determine if patients are receiving the necessary care and achieve viral suppression.

Practical Recommendations

The following practical recommendations are suggested to support the implementation of this plan:

• Ensure that healthcare providers can access the most recent informational resources on HIV prevention techniques.
• Create procedures and processes to facilitate both regular and targeted HIV testing.
• Continue to educate and assist primary care practitioners in the implementation of EHR-based interventions.
• Create alliances with community-based groups to aid in HIV management and prevention.
• Guarantee that patients can receive assistance when they need it, including case management and mental health services.

Conclusion

Primary care practitioners are essential in the prevention and treatment of HIV. This primary care plan presents an in-depth approach to HIV prevention involving EHR-based interventions, education, testing, and treatment. The plan also emphasizes the need for routine HIV testing for people who are sexually active and at risk. Pre-exposure prophylaxis and post-exposure prophylaxis are also emphasized as effective strategies for reducing HIV transmission. Implementing this approach has the potential to reduce HIV transmission rates and improve the health outcomes of people living with HIV. To conclude, Healthy People 2030’s aims for health prevention and disease prevention are consistent with the plan of action suggested here to reduce HIV transmission in primary care environments.

References

Fuchs, J. D., Stojanovski, K., Vittinghoff, E., McMahan, V. M., Hosek, S. G., Amico, K. R., Kouyate, A., Gilmore, H. J., Buchbinder, S. P., Lester, R. T., Grant, R. M., & Liu, A. Y. (2018). A mobile health strategy to support adherence to Antiretroviral Preexposure Prophylaxis. AIDS Patient Care and STDs, 32(3), 104–111. Web.

Healthy People 2030. (2023). Healthy People 2030: Building a healthier future for all. Health.gov. Web.

Kabapy, A. F., Shatat, H. Z., & Abd El‐Wahab, E. W. (2020). Attributes of HIV infection over decades (1982–2018): A systematic review and meta‐analysis. Transboundary and Emerging Diseases, 67(6), 2372-2388. Web.

Kiptinness, C., Kuo, A. P., Reedy, A. M., Johnson, C. C., Ngure, K., Wagner, A. D., & Ortblad, K. F. (2022). Examining the use of HIV Self-Testing to support PrEP delivery: A systematic literature review. Current HIV/AIDS Reports, 19(5), 394-408. Web.

Sulat, J. S., Prabandari, Y. S., Sanusi, R., Hapsari, E. D., & Santoso, B. (2018). The validity of Health Belief Model variables in predicting behavioral change. Health Education, 118(6), 499-512. Web.

The Centers for Disease Control and Prevention (CDC). (2023). HIV Pre-exposure Prophylaxis (PrEP) Care System. CDC. Web.