Patient-Centered Primary Care for HIV at ANAC 2018

Heather Boerner

November 01, 2018

DENVER — Patricia Cioe, RN, NP, PhD, had no intention of becoming an HIV provider when she took a job at an urgent care center in 1995. But then a young man came in with all the signs of AIDS-defining illnesses.

Cioe tested the man, confirmed her suspicion, and consulted with the HIV clinic at Rhode Island Hospital. She never forgot him.

In fact, she treated him for years, providing his primary care while the doctor at the HIV clinic managed his HIV medications. She transferred to that clinic in 2001 and has been an HIV primary care provider ever since.

"HIV has become much more of a primary care issue" with the advent of simplified treatment regimens that suppress the virus, Cioe told Medscape Medical News.

In fact, people living with HIV can be "quite healthy," she added. But now that they are living longer, diseases of aging are increasingly becoming an issue in this population.

Cioe, a nurse practitioner from Brown University in Providence, Rhode Island, will be honored at the upcoming meeting of the Association of Nurses in AIDS Care (ANAC) 2018 with the Researcher of the Year Award for her work on cardiovascular risk reduction in people living with HIV.

Until recently, for people who have been living with HIV for a long time, cardiovascular disease and other illnesses, such as hypertension and diabetes, "haven't been our focus," said Carol Dawson-Rose, RN, PhD, from the University of California, San Francisco, who is cochair of the ANAC.

"We've been so focused on keeping people alive and on medication that some other chronic illnesses really need to be addressed now," she added.

Cioe and others will present data on smoking cessation, e-cigarettes as a potential harm-reduction tool for people living with HIV, and other approaches to improve quality of life as people with HIV age.

In addition to sessions addressing the primary care needs of people living with HIV, the conference will tackle the larger question of what patient-centered care really means for this population.

Patient-Centered Care

One of the foundations of nursing is a patient-centered, holistic approach to care, said Dawson-Rose, but this year, the conference will include more types of providers in their discussions and explore ways to heal the whole person.

The ANAC recently expanded its bylaws to include not just registered nurses, nurse practitioners, and other providers with nursing degrees, but also pharmacists, social workers, psychologists, and other care professionals. The idea is to make the organization and the conference transdisciplinary, she said.

To that end, research will be presented that will challenge providers to move beyond behavior-based treatment.

There will be plenaries on trauma-informed care and transgender health and military service. And a presentation on a distinctly Native American healing paradigm for people defined as gender-nonconforming or transgender in Western terms will look at methods providers can use to understand their patients and truly meet them where they are.

Plus, a session will provide data and explore how providers can spot their own implicit bias when treating patients of different ages, races, and genders than themselves.

What can we do to better address the whole person? "And how do we bring that into our care?" Dawson-Rose asked. "That is one of the themes of the conference."

Because Dawson-Rose primarily works with women living with HIV, she sees, on a daily basis, the impact repeated experiences of lifetime trauma, living in violent communities, and living in communities affected by mass incarceration can have on the ability of patients to follow through on treatment regimens. And that is to say nothing of the stigma and trauma that can be associated with an HIV diagnosis.

Several sessions will examine the link between trauma, mental health problems, and substance use, an issue previously reported by Medscape Medical News.

It might require providers to focus less on trying to change behavior and more on asking about a patient's experiences. "Nurses are already well versed in these activities, but there are also specific approaches we can take," Dawson-Rose said.

This is especially important because the Support for Patients and Communities Act, passed by Congress in October, will allow nurse practitioners and others to prescribe medication-assisted treatment.

Cioe and Dawson-Rose have disclosed no relevant financial relationships..

Follow Medscape Nurses on Twitter @MedscapeNurses and Heather Boerner @HeatherBoerner

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