Barriers and Facilitators in Readiness to Adopt Rapid HIV Testing Among Healthcare Workers in Chile

Oral rapid HIV testing (ORT), which is an alternative to the Enzyme-linked Immunosorbent Assay (ELISA) for HIV, has the potential to help Chile meet its national HIV prevention goals of increased testing and early entry into treatment. This study examined individual factors affecting Chilean healthcare providers’ readiness to adopt ORT and their perceived comfort in performing the test. This study used a cross-sectional survey design. A total of 150 nurses, midwives, and physicians participated in the study, and they were all employed at four clinics of the University Católica de Chile health network in Santiago. The participants completed a self-administered survey that included questions about their demographic characteristics, attitudes towards and experience with evidence-based practice (EBP), and AIDS-related attitudes and beliefs, including HIV-related stigmatization, perceived importance of HIV testing, and perceived comfort performing rapid HIV tests. Results showed that providers had a mean Readiness to implement ORT score of 15.1 on a scale of 0-20, with higher scores indicating higher readiness. Educational background, Beliefs about evidence-based practice, Perceived comfort performing rapid HIV test (PCP-ORT), and Perceived importance of HIV testing explained 43.6% of the variance in readiness to adopt ORT. Perceived comfort performing rapid HIV test was the strongest predictor of Readiness to adopt ORT. Developed for this study, this scale asked about level of comfort in performing pre-test counseling, giving an oral test, giving a finger-prick test, giving a positive test and post-counseling, and giving a negative test and post-counseling. Results showed a mean score of 16.21 (range 0-20). Participants felt least comfortable with giving positive test results and providing appropriate post-test counseling to patients. Stigmatizing attitudes were negatively related to Perceived Comfort Performing ORT. This finding highlights the need to address HIV-related stigmatization among healthcare providers and to offer ORT training, focusing on giving positive test results so that they can be truly comfortable performing ORT. This is the first pre-implementation study in anticipation of the possible introduction of ORT in Chile, and the results can guide preparations for ORT implementation by identifying and addressing potential barriers related to individual provider readiness to implement ORT

Observed Use of Standard Precautions in Chilean Community Clinics

OBJECTIVE: In Chile, little information about the use of standard precautions (SP) among health care workers (HCWs) exists. As part of a larger study to tailor and test an HIV prevention intervention for community HCWs, this study describes the observed frequency with which appropriate SP were used by HCWs in low-income community clinics of Santiago. Also, the availability of supplies is described. SAMPLE: A total of 52 structured observations with potential contamination with body fluids were done. RESULTS: HCWs used SP inconsistently, especially neglecting hand washing, surface cleaning, and cleaning of shared materials. Lack of materials contributed in some instances of failure to use SPs, especially wiping surfaces and safe disposal of sharp instruments, as shown by a positive correlation between use of SP and availability of materials. Essential materials were usually available. Although more education should relate to a better understanding of the importance of SP, no difference was found between professionals and paraprofessionals in the use of SP. CONCLUSIONS: It is clear that the initial training, continuing education, and ongoing support for practicing SP are not adequate. Training should be offered to HCWs involved in caring for clients at community clinics to stop the spread of HIV or other infectious diseases in health care settings

HIV-Related Stigma and Multidimensional Frailty Among Older Latinos With HIV

Introduction: Frailty is a geriatric syndrome of increased vulnerability to stressors marked by a higher risk for poor health outcomes. HIV-related stigma is a stressor for Latino people with HIV (PWH) and an important barrier to HIV care. This study examines the association between HIV-related stigma and multidimensional frailty among older Latino PWH. Methods: A cross-sectional design with 120 Latino PWH aged 50 and older was used. Self-reported questionnaires were administered to assess multidimensional frailty (Tilburg Frailty Indicator) and HIV-related stigma (HIV stigma scale). Results: Participants were 59.1 ± 7.0 years old, primarily White-Hispanic (85.00%, n = 102), single (48.33%, n = 58), and male (73.30%, n = 88). Nearly half of the participants were frail (45.85%, n = 55). Compared to non-frail, frail individuals had significantly higher scores in the total HIV-related stigma ( M = 98.5 ± 24.7 vs. M = 85.3 ± 25.6, p = .020) and all subscales. The odds of multidimensional frailty were 1.021 times higher for people with higher HIV-related stigma scores ( p = .007). This association remained significant after adjustment for income and comorbidities ( p = .049). Conclusions: HIV-related stigma among older Latino PWH was significantly associated with their odds of being frail. Efforts to prevent multidimensional frailty should consider addressing HIV-related stigma through age-appropriate and culturally tailored resources for this group

HIV Testing Among Heterosexual Hispanic Women in South Florida

Purpose The purpose of this study was to examine the influence of selected facilitators, barriers, beliefs, and knowledge suggested by the literature to be associated with human immunodeficiency virus (HIV) testing among heterosexual Hispanic women. Design This study utilizes a cross‐sectional design to analyze secondary data from SEPA III: The Effectiveness Trial. SEPA stands for Salud, Educacion, Prevencion y Autocuidado, which translates to Health, Education, Prevention, and Self‐Care. The Social Cognitive Model (SCM) guided this study. Methods Three hundred twenty heterosexual Hispanic women 18 to 50 years of age participated in this study. Data were analyzed using descriptive statistics and logistic regression. Findings The most common facilitators for HIV testing were receiving recommendations from a healthcare provider (HCP) and the test is offered by an HCP rather than women asking for it. The most common barrier to testing was having no reason to believe they were infected. Most women believed a positive test result would encourage them to take better care of themselves. However, as much as 15% of women reported desires to kill or hurt themselves if they test positive. On the other hand, a negative result would make them assume their partners are negative and thus do not need to be tested. Significantly, explanatory variables related to HIV testing were knowledge and the HIV test is offered by an HCP instead of women asking for it. Conclusions Strengthening HIV knowledge and offering HIV tests are significant contributions that nurses make to the health of Hispanic women. The SCM can be used to design programs to increase HIV testing among Hispanic women. Clinical Relevance Nurses are encouraged to offer testing and provide culturally competent HIV prevention education to increase HIV testing among Hispanic women

Mano a Mano-Mujer

The impact of a professionally-facilitated peer group intervention for HIV prevention among 400 low income Chilean women was examined using a quasi-experimental design. At three months post-intervention, the intervention group had higher HIV-related knowledge, more positive attitudes towards people living with HIV, fewer perceived condom use barriers, greater self-efficacy, higher HIV reduction behavioral intentions, more communication with partners about safer sex, and decreased depression symptoms. However, they did not have increased condom use or self-esteem. More attention to gender barriers is needed. This intervention offers a model for reducing HIV for women in Chile and other Latin American countries