Agreement Between Medical Record Data and Self-Reported

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Agreement between Medical Record Data and Self-Reported

CD4 Counts, Viral Loads and Medication Knowledge

Joachim Voss1

Annushka Cesan1

Kristie Eilers2

Shauna Applin2

1University of Washington, Seattle, USA

2Community Health Care, Tacoma, USA

Background: For people living with HIV (PLWH), we expect them to see their providers routinely every quarter to check the laboratory values, explain those results to our clients and discuss any problems with taking antiretroviral treatment regimens (ART). While regimens have become so much easier to take, we really do not know how well those improvements have translated into a better understanding of patient knowledge.

Purpose: We wanted to determine whether a community sample of men and women with HIV were able to accurately self-report their most recent CD4 count, viral load, and ART regimen, and whether demographic differences such as age and gender influenced self-reporting.
Methods: We collected data from (N=200) PLWH and asked them to recall their last CD4 count, their last viral load, and identify their medication regimen with a medication sheet that listed the generic and trade name. The data was collected in a large primary HIV clinic and a community clinic in the North West between May and July of 2010.

Findings: We found moderate agreement between self-report and medical record data for CD4 count (k=.58, p<.001), and viral load (k=.43, p<.001), but only 43% were able to recall their ART regimens accurately. For PLWH ≥ age 50 (k=.77, p<.001), and those with health insurance coverage (k=.61, p<.001) were more accurate to self-report CD4. Women were more accurate in reporting viral load than men (k=.53, p=.003 vs. k=.38, p<.001).

Conclusions: Even with the vast improvements of patient monitoring and treatment modalities, half of our patients only partially understand the information we are trying to convey to them.

Implications for Practice: As HIV patients live longer with the disease, PLWH need multiple modalities of education (for example, visual aids, teach-back method, video) to relate CD4 counts, viral load, and ART regimens to their personal health understanding and to be meaningful to them.

Objectives: The learner will be able to:

• Discuss the importance of self-report in relationship to medication regimens and HIV illness indictors;
• Understand the relevance of Kappa statistics.

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Home-based Navigator Services for PLWH and Other Chronic Conditions

Jacquelyn Slomka1

Allison Webel1

Maryjo Prince-Paul1

Thomas Quinn2

Barbara Daly1

1Case Western Reserve School of Nursing, Cleveland, Ohio, USA

2Hospice of the Western Reserve, Cleveland, Ohio, USA

Background: As persons living with HIV (PLWH) survive into older adulthood, they are at risk for chronic conditions in addition to HIV. Comprehensive palliative care services to provide physical, psychosocial and spiritual care, symptom management, advance care planning, and improvement in overall quality of life are needed. Models of palliative care that exist for PLWH are often institution-based. Our program was developed to provide home-based palliative care services and health care system navigation for high-risk PLWH.

Purpose: This presentation provides an overview of an HIV Navigator Program, developed to test the provision of palliative services and health system navigation in addition to standard health care for PLWH and other chronic conditions.

Methods/Practice: In partnership with and modeled after a community-based palliative care navigation project, a program was developed to address specific health, psychosocial and spiritual needs of PLWH and other chronic conditions. Home-based palliative care assessment, services and assistance in navigating complexities of the health care system are provided by an Advanced Practice Nurse, a Licensed Social Worker and trained volunteers. Measurable program outcomes over a 36-month period include quality of life, symptom burden, coping ability, and advance care planning.

Conclusions: Specific and unique needs of high-risk PLWH can be addressed through palliative care navigation programs, but evaluation of different models is needed.

Implications for Practice: Attention to palliative care needs of PLWH and other chronic conditions is essential because of the increasing prevalence of HIV, the rise in chronic diseases, and the aging of the population of PLWH.

Objectives: The learner will be able to:

• Describe background and implementation of an HIV Navigation Program for early palliative care;
• Discuss challenges in developing and implementing an HIV Navigation program.

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Beyond KS, Importance of Nursing Assessment in

KSHV-associated Malignancies and Syndromes

Kathleen Wyvill

Karen Aleman

Robert Yarchoan

Mark Polizzotto

Thomas Uldrick

HIV and AIDS Malignancy Branch, CCR, NCI, Bethesda, MD, USA

Background: As people with HIV/AIDS live longer, malignancies are an increasingly important cause of mortality.

Purpose: Increase awareness of KSHV-related syndromes and malignancies in HIV and Infectious diseases practices

Methods/Practice: Kaposi’s sarcoma associated herpesvirus (KSHV) causes not only Kaposi’s sarcoma (KS), but also KSHV-multicentricCastleman’s disease (MCD), primary effusions lymphoma (PEL) and the more recently described KSHV inflammatory cytokine syndrome (KICS), which can accompany KS or PEL. Our research team studies KSHV-related syndromes and malignancies. Many patients we assess come to us critically ill as diagnosis was delayed or missed. Patients with KSHV-MCD or KICS may present with systemic inflammatory symptoms including fevers, cachexia, and laboratory abnormalities including cytopenias, hypoalbuminemia, hyponatremia, and elevated C-reactive protein. By recognizing the signs and symptoms earlier, in primary care practices, emergency rooms and intensive care units, nurses can help identify patients who may need further assessment and potentially treatment for these diseases.

Conclusions: Although our goal is an AIDS-free generation, until there is a cure for AIDS, existing generations of HIV infected people are living longer, and cancer, including KS and PEL, will remain an important health care issue for HIV-infected patients.

Implications for Practice: Careful nursing assessment of HIV positive patients with inflammatory symptoms is critical to successful outcomes. Specialized multidisciplinary care is required.

Objectives: The learner will be able to:

• Identify the signs and symptoms of KSHV-MCD, PEL and KICS;
• Describe treatments and supportive care measures for MCD, PEL.

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HIV-Related Sexual Risk Behaviors Among Older

Urban African American Women

Tanyka Smith

Columbia University, New York, NY, USA

Background: In the Northeastern United States, older African American women are disproportionately affected by HIV as they constitute the fastest growing group newly infected with the disease. Sexual risk and protective behaviors may be influenced by individual factors, including attitudes, perceptions, beliefs and socio-cultural and contextual factors. However, there is limited research on sexual risk behaviors and effective HIV prevention strategies that are tailored to the needs of older African American women.

Purpose: The purpose of this study was to examine the relationship among HIV-related behavioral beliefs, normative beliefs, control beliefs and gender power and examine how such relationships influence condom use intentions and consistent condom use behavior among older urban African American women.

Methods: A convenience sample of 175 older African American women, age 50 to 85, were recruited from low income neighborhoods in New York City. Participants were recruited from places where older African American women typically assemble including hair salons, senior/community centers, food markets, and community health centers. Data were collected via self-administered paper-and-pencil questionnaires.

Results: The logistic regression model revealed several significant predictors of condom use intentions, including: condom negotiation efficacy (OR = 1.4, p = < .01), perceived HIV risk (OR = 1.1, p < .05), perception of main partners' beliefs (OR = 1.7, p < .01), alcohol use (OR = .69, p < .05) and marital status (OR = .16, p < .05). Findings also indicated that consistent condom use was associated with perception of HIV risk (OR = 1.2, p < .01), perceived social support (OR = 1.2, p = .04), condom use self-efficacy (OR = 1.1, p < .01) and sexual relationship power (OR = 1.2, p = .05).

Conclusion: The results of this study suggest that older African American women engage in high risk sexual practices and are vulnerable to HIV. This study provides a basis for future culturally relevant HIV prevention interventions for this population.

Implications: Nurses and other health care providers are in a prime position to assess the HIV sexual risk practices of older African American women and provide appropriate risk reduction education and condom negotiation training.

Objectives: The learner will be able to:

• Identify the theoretically-based individual and the socio-cultural factors influencing the HIV sexual risk and protective behaviors among older urban African American women;
• Describe effective nursing strategies to promote consistent condom use that are culturally-specific and age-appropriate to reduce the risk of HIV in this vulnerable population.

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American Dream and HIV: HIV+ Asian Immigrants' Self-Actualization

Wei-Ti Chen

Yale University, NY, USA

Background: Asians and Pacific Islanders (APIs) are among the fastest growing minority groups in the United States. This population growth has been accompanied by a notable increase in HIV incidence. APIs are the only racial/ethnic group to show a significant increase in HIV diagnosis rate between 2001 and 2008. Despite these increasing numbers, in HIV-related studies, data are seldom collected specifically on APIs. The availability of data on HIV among API Americans are especially limited and little is known about the immigrants' acculturation, self-actualization, their "American Dreams", quality of life, perceived stress, and self-management among HIV-positive API Americans.

Purpose: In this study, we explored how acculturation, self-actualization and perceived stress affect depression symptomatology in the HIV-positive API population.

Methods: A mixed-methods study was conducted between January to June of 2013. Thirty in-depth interviews were conducted with HIV-positive API in San Francisco (n = 16) and New York (n = 14). Additionally, cross-sectional audio computer-assisted self-interviews (ACASI) were conducted with a convenience sample of 50 HIV-positive API (29 in SF and 21 in NY).

Conclusion: Three major themes were extracted from the in-depth interviews: self-actualization, acculturation stress, and depression. Then, a moderated mediation analysis for the relationship among acculturation, self-actualization and perceived stress was deployed. For those who are highly acculturated to the US, perceived stress was not related to depression symptomatology. For those who had low and moderate acculturation, stress significantly mediated depression symptomatology. In addition, among those who had low acculturation, there is a significance in depression symptomatology scores between those who totally lost their self-actualization and who still believe they can still make the dreams come true (p = .02). For those who had the high acculturation, their HIV is not significantly related to the self-actualization.

Implications for Practice: This study found that acculturation levels influenced perceived stress and depression in the HIV-positive Asian immigrant population. Lower acculturated Asian Americans suffered to achieve less self-actualization. Future interventions should focus on enhancing acculturation and reducing perceived stress, which may prompt harmful coping behaviors, such as high-risk sex and substance abuse, to decrease depression, then, achieve their American Dreams.

Objectives: The learner will be able to:

• Understand the perceived stress in Asian & Pacific Islanders' HIV+ population;
• Know the self-actualization in Asian & Pacific Islanders' HIV+ population;
• Be aware that enhancing the acculturation in HIV+ API immigrants is very important to decrease perceived stress, increasing coping strategies and later, achieve their American Dreams.

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"Is Your Man Stepping Out?” An Online Pilot Study to Evaluate Facebook

Advertising and Retention using Smartphones to Deliver HIV Prevention

Videos to African American Young Adult Women

Rachel Jones

Lorraine Lacroix

Northeastern University, Boston, MA, USA

Background: Love, Sex, and Choices (LSC) is a popular online 12-episode soap opera video series to reduce HIV risk in young urban African American women. A video guide commentator was added to LSC to direct focus to critical themes.

Purpose: An online pilot study was conducted to evaluate: 1) acceptability of the new guide enhanced LSC, and feasibility of, 1) Facebook (FB) advertising, 2) completing an online screening interview, 3) inclusion of high risk 18-29 year old women, 4) consenting, 5) verifying eligibility, 6) streaming LSC to smartphones, and, 7) retention at 30 days.

Methods: FB ads targeted zip codes in high HIV incidence areas. Ads ran for 30 days on FB users’ smartphones or computers. Clicking the ad led to the study FB page and website to consent and screen. If high risk, participants watched LSC and completed a follow-up interview at 30 days. Viewing times and ad clicks were tracked.

Results: FB ads appeared in newsfeeds of 383,873 FB users. Of 6,537 clicks, most (n=5,393, 82.5%) were mobile users; 230 screened. 84 were high risk, 40 watched LSC. 39 completed follow-up. Most (n=23, 57.5%) were African American/Black. Mean age= 23. Some (n=17, 43%) had privacy concerns when clicking the FB ad, but all 40 felt the survey was confidential on the study website. At baseline, 40 reported unprotected sex with high-risk partners during the past 90-days, compared to 7 at 30 days post-intervention. 17 (43.6%) were HIV tested. 37 related to the video characters. 38 felt the guide emphasized important messages. High performing ads featured, “Is your man stepping out?” The cost per completer was $37.74.

Conclusions/Implications: The Guide was highly evaluated. Online recruitment/ retention of at-risk mostly African American young urban women over a large geographic area suggested wider reach than traditional recruitment. A low percent clicked the ad and completed (0.61%), but recruitment of high risk women at 10/week compared favorably to 7 /week in previous field recruitment and nearly all were retained. Field recruitment is more targeted. Online takes less time, may be less costly, with higher geographical reach. A substantial number went for HIV testing.

Objectives: The learner will be able to:

• Describe ways to reach a target population with engaging Facebook advertisements to recruit into an online HIV prevention study;
• Describe considerations to obtain online consent, verify, track, and retain participants in an online study;
• Describe how mobile devices were utilized to receive FB ads and to deliver a video intervention and facilitate retention;
• Describe rationale for an epilogue by a video guide commentator to emphasize key messages in entertainment-education.

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Waiving Parental Consent: Panacea for Gaps in Adolescent

LGBT HIV Prevention Research?

D. Dennis Flores1

Joyell Arscott1

Julie Barroso2

1Duke University, Durham NC, USA

2University of Miami, Miami, FL, USA

Background: Most research on HIV prevention for young gay, lesbian, bisexual and transgender (LGBT) individuals rely on retrospective designs due to the perceived difficulty of conducting cross-sectional studies with self-identifying LGBT adolescents. Since retrospective studies do not capture issues as they occur, sexual health research when LGBT youth are navigating both puberty and sexual identity formation is sparse. Obtaining a waiver of parental consent is necessary because seeking parental permission to join sexuality-focused studies may signal to parents that their children are not heterosexual.

Purpose: This report will detail how obtaining a waiver of parental consent is possible to enable the participation of LGBT youth in meaningful research.

Methods: The IRB application included detailed arguments about how studies that waived parental consent have been successfully conducted in peer institutions, how research findings produced significant and rich results, how LGBT youth are autonomous and capable of providing informed consent similar to their heterosexual peers, and how excluding this complex population from research violates the principles of beneficence, justice and respect for persons. Other elements included in the waiver request was a list of studies that effectively recruited LGBT participants under the age of 18, institutional support letters from bioethicists and child advocacy experts, and anticipated human subjects protection concerns and how they would be addressed.

Conclusions: The waiver of parental consent was granted by the full IRB after months of deliberation. In order to improve HIV prevention efforts and the sexual health outcomes of LGBT youth, this population must be allowed to participate in real time studies about their own health.

Implications for Practice: To properly safeguard self-identifying LGBT youth and to encourage research informed by their current social milieu, waivers of parental consent may be necessary. From our experience, these waivers can be a design feature that will assuage LGBT youths’ concerns about participating in research about them.

Objectives: The learner will be able to:

• Describe how to obtain a Waiver of Parental Consent from the IRB;
• Enumerate the reasons why Waivers of Parental Consent may be necessary in HIV prevention research.

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Anal Cancer Screening and Follow Up in HIV-Infected Individuals

Jessica Holmes,

Marcia Holstad

Deborah Bruner

Emory University, Atlanta, GA, USA

Background:HIV-infected individuals are 28 times more likely to be diagnosed with anal cancer than the general population. Screening and the timely treatment and proper follow up of anal precancerous lesions is suspected to prevent anal cancer.

Purpose:To examine rates of anal Pap screening and follow up rates after an abnormal anal Pap test in a sample of HIV-infected individuals.

Methods/Practice:This pilot study used a retrospective descriptive design to review randomly selected medical records of male patients seen at a large comprehensive HIV clinic and enrolled in its Infectious Disease Program (IDP). This chart review also used a random selection of female participants from a list of unlinked medical record numbers from the closed KHARMA study that recruited HIV-infected women also enrolled in the IDP. Data analyses included Pearson's or Spearman Rho correlations, Chi-square tests, and independent sample t-tests.