The professional skills of the nurse involved in the care of individuals with sexually transmitted infections

INTRODUCTION: Sexually Transmitted Infections (STIs) represent a relevant public health issue that requires the combined contribution of different health care professionals in order to put in place proper prevention, diagnosis and treatment activities  METHODS: The Integrated health care model (PIC) is here applied to STIs. Designed as a territorial network of services including a multidisciplinary team of health care workers, this model works across a number of settings and levels of care. The specific contribution of the nurse with an adequate technical-scientific and relational communication background in STI care provision is analyzed.  RESULTS: Nurses and other Health Care Workers involved in the PIC for STIs are able to respond in a tailored manner to the various health needs of the person. The technical-scientific and relational communication competencies ensure the delivery of quality services. Moreover, nursing care should be STIs person-centred and used for to improve empowerment and healthy behaviors. Appropriate nursing staff education and training aimed at integrating technical-scientific knowledge with relational communication skills on STIs is highly desiderable.  CONCLUSIONS: Nurses area a crucial component in the PIC for STIs, because they are engaged in the care of a complex, delicate and intimate component of the individual. Therefore, to improve service performance, an improvement and extension of nurses duties in STI centers would be highly desirable. Standardized care protocols established by the local Health Department could be used as direction as well as an updating of the current Italian legislation which does not allow to adapt nursing competencies to the real care requirements.  KEYWORDS: sexually transmitted infections, Italy, nurses, integrated care, training, health communication.INTRODUZIONE: Le Infezioni Sessualmente Trasmesse (IST) rappresentano a livello nazionale un importante problema di sanità pubblica che richiede interventi di prevenzione, diagnosi e cura condotti attraverso la collaborazione integrata di professionisti sanitari differenti.  METODI: È stato utilizzato il modello di Percorso Integrato di Cura (PIC) applicandolo alle IST, inteso come rete territoriale che prevede il coordinamento tra le diverse strutture sanitarie e tra i vari operatori sanitari coinvolti in questa specifica area. In tale ambito è stato analizzato il possibile contributo che il professionista infermiere, con un bagaglio tecnico-scientifico e comunicativo-relazionale adeguato, può fornire alla persona direttamente o indirettamente coinvolta in una IST.  RISULTATI: La conduzione di un intervento infermieristico professionale all’interno del PIC per le IST, ovviamente integrato con quello di altre figure professionali, intende rispondere in modo personalizzato ai diversi bisogni di salute espressi dalla persona. Inoltre, mira a promuovere nella persona con IST l’attivazione di processi di empowerment fondamentali per la messa in atto di stili comportamentali adeguati. Emerge, pertanto, l’esigenza di proporre al personale infermieristico un percorso di formazione/aggiornamento finalizzato all’integrazione delle conoscenze tecnico-scientifiche con quelle comunicativo-relazionali in tema di IST.  CONCLUSIONI: Il ruolo dell’infermiere costituisce un elemento cruciale all’interno di un PIC per le IST in quanto impegnato in un’area complessa e delicata che tocca la sfera più intima della persona coinvolgendola nella sua globalità. Appare, pertanto, fortemente auspicabile un ampliamento delle competenze dell’infermiere attraverso, prima, una elaborazione di protocolli aziendali standardizzati stabiliti dalla Direzione Sanitaria in cui opera il professionista infermiere, e successivamente un superamento della normativa vigente che ad oggi non consente di adeguare le competenze infermieristiche alle reali esigenze assistenziali.  PAROLE CHIAVE: infezioni sessualmente trasmesse, Italia, infermiere, percorso di cura integrato, formazione, epidemiologia, comunicazione&nbsp

Estimated burden of Chlamydia trachomatis female infection and consequent severe pelvic inflammatory disease, Italy, 2005-2016

Chlamydia trachomatis (Ct) is the leading sexually transmitted infection (STI) across Europe. In Italy, prevalence is low in general population; anyway, predominance of asymptomatic infections, passive voluntary reporting, variable diagnostic criteria and coding practices suggest for considerable underestimation, preventing assessment of real burden of disease and health intervention. We analysed data on female genital Ct infection registered in STI sentinel surveillance systems in Italy from 2005 through 2016 and found 3,305 women. Among them, those aged 20-24 years had the highest disability-adjusted life years (DALYs) estimation equal to 106.77 DALYs per 100,000-stratum specific population. Through the study period, incidence rate (IR) for female Ct infection increased significantly from 2.9 to 7.1 per 100,000 resident population. Besides, we analysed data on pelvic inflammatory disease (PID) sequela reported from the National Hospital Information system (NHIS) in the same period. We found 287 women hospitalised with concurrent PID and Ct infection. We recommend targeted screening programmes in women aged 20-24, definition of nationwide active surveillance system, standardisation of diagnostic criteria and ICD-9CM coding practices

Incidence of Newly HIV Diagnosed Cases among Foreign Migrants in Italy: 2006-2013

Objective: In Europe, during the last years the proportion of foreign migrants among AIDS and HIV cases is growing. In Italy, the number of new cases of HIV represented by foreign migrants has progressively increased, but the new HIV diagnoses incidence among foreign migrants has decreased, because of the increase in the total number of foreign migrants in recent years. Nevertheless, the new HIV diagnoses incidence among foreign migrants is still high if compared to that among Italians. The aim of the study was to analyze the characteristics of foreign migrants with a new HIV diagnosis and the new HIV diagnoses incidence among foreign migrants diagnosed in Italy between 2006 and 2013. Methods: The new diagnoses incidence was calculated as the ratio between the number of new HIV diagnoses among foreign migrants and the number of foreign migrants residing in Italy. The new HIV diagnoses incidence was compared with that among Italians using the standardized incidence ratio (SIR) adjusted by age and gender. Results: During the study period (2006-2013), of the 25,545 new diagnoses reported by the HIV surveillance system, 28.8% were among foreign migrants. The incidence of new HIV diagnoses among foreign migrants for the entire study period was 26.7 cases per 100,000 foreign migrant residents, compared to 5.1 per 100,000 among Italians. The incidence of new HIV diagnoses decreased over time for foreign migrants: from 42.5 per 100,000foreign migrant residents in 2006 to 20.0 per 100,000 foreign migrant residents in 2013, whereas for Italians it remained stable. The SIR confirmed the marked difference between the two populations: specifically the overall incidence of new diagnoses was more than four times higher among foreign migrants, compared to Italians.Conclusion: The results stress the need to reinforce the efforts aimed at reducing the circulation of HIV in this population

Continued high prevalence of HIV, HBV and HCV among injecting and noninjecting drug users in Italy

We estimated the prevalence of HIV, HBV and HCV infections among injecting and non-injecting drug users treated within public drug-treatment centres in Italy to determine the correlates of infection. In the sample of 1330 drug users, the prevalence of HIV was 14.4% among drug injectors and 1.6% among non-injectors; the prevalence of HBV was 70.4% among injecting drug users and 22.8% among non-injectors and of HCV was 83.2% among injecting drug users and 22.0% among non-injectors. Old age, unemployment, and intravenous drug use were significantly correlated with each of the infections, as well as a longer history of injecting drug use. The results indicate that these infections continue to circulate among drug users, highlighting the need for monitoring of this group in Italy

The continued ageing of people with AIDS in Italy: recent trend from the national AIDS Registry

Introduction. In industrialized countries, the availability of highly active antiretroviral  therapy (HAART) caused a slow but substantial ageing of the AIDS epidemic mainly  due to the longer survival of persons with HIV/AIDS which has turned HIV into a manageable, chronic disease. The number of older people with AIDS is growing in many  European countries.We described the impact of AIDS among persons aged 50 years or more in Italy and  compared the characteristics of these cases with those of persons diagnosed with AIDS  at an age younger than 50. Methods. The source of data was the Italian AIDS Registry, from 1982 to 2011. We  defined “older” persons those aged 50 years or more, and younger individuals those aged  less  than  50  years.  We  built  two  multivariate  logistic  regression  models:  the  first  one  to identify factors associated with being older, and the second one to identify AIDS-defining diseases correlated with being older. Variables with a P value of < 0.05 were  entered in the model.Results. Of the total AIDS cases, 10.5% were among persons older than 49 years. This  proportion progressively increased from 0.0% in 1983 to 26.4% in 2011. Among older  cases, the incidence of AIDS was 2.0 per 100 000 residents in 1996, then decreased  to 1.4 per 100 000 in 2000 and levelled off around 1 per 100 000 residents until 2011.  Compared to younger cases, older cases were more frequently males, Italians, diagnosed  with AIDS in recent years, residing in Northern or Central Italy, non-injecting drug users, and late testers. Discussion. These findings stress the need for physicians to consider carefully the possibility of HIV infection among older individuals not to miss the opportunity to deliver  prevention messages, offer HIV testing, and make an early diagnosis.  

Sexuality education in Italy 2016-2020: a national survey investigating coverage, content and evaluation of school-based educational activities

Comprehensive sexuality education is an important means of promoting sexual well-being amongst young people and is key to preventing sexually transmitted infections (STIs). However, sexuality education is not currently included in the formal curriculum in Italian schools. The aim of this study was to develop an inventory of schoolbased sexuality education (SBSE) activities carried out by external providers and implemented in Italy from 2016 to 2020. A desk review and survey were carried out. In the desk review online documents on STI prevention were analysed. The survey investigated the providers, objectives, content and methods used to implement SBSE activities in secondary schools. Findings revealed a highly heterogeneous situation in terms of geographical coverage, service providers, objectives and evaluation. Some SBSE activities were classified as adopting a comprehensive approach to sexuality education, while the majority focused on STI prevention, and many were single-session activities. Although most activities were said to have been evaluated no results were available. The data showed that SBSE is not systematically and equally delivered across Italy. Action is needed to provide young people with evidence-based, age-appropriate and accurate education about sexual and reproductive health and wellbeing

Estimates of the Number of People Living with HIV in Italy

Objective. To estimate the HIV prevalence and the number of people living with HIV (PLHIV) in Italy with a projection for 2020. Methods. Two methods elaborated by Joint United Nations Programme on HIV/AIDS (UNAIDS) were used: Estimate and Projection Package and Spectrum. Results. A total of 123,000 (115,000–145,000) individuals aged 15 or more were estimated to be living with HIV in Italy at the end of 2012 and the estimated HIV prevalence was 0.28 (0.24–0.32) per 100 residents aged 15 or more. In 2012, the estimated number of new HIV infections among adults was 3,000 (2,700–4,000), and the number of adults in need for ART was 93,000 (80,000–110,000). The projection estimates that 130,000 (110,000–150,000) adults will live with HIV/AIDS in 2020 in Italy. Conclusion. Estimates of PLHIV in Italy stress the high number of PLHIV in need of care and treatment, as well as the need for more information and prevention campaigns

Estimating minimum adult HIV prevalence: a cross-sectional study to assess the characteristics of people living with HIV in Italy

In 2012, we conducted a retrospective cross-sectional study to assess the number of people living with HIV linked to care and, among these, the number of people on antiretroviral therapy. The health authority in each of the 20 Italian Regions provided the list of Public Infectious Diseases Clinics providing antiretroviral therapy and monitoring people with HIV infection. We asked every Public Infectious Diseases Clinic to report the number of HIV-positive people diagnosed and linked to care and the number of those on antiretroviral therapy during 2012. In 2012, 94,146 people diagnosed with HIV and linked to care were reported. The majority were males (70.1%), Italians (84.4%), and aged between 25 and 49 years (63.4%); the probable route of transmission was heterosexual contact in 37.5% of cases, injecting drug use in 28.1%, and male-to-male contact in 27.9%. Among people in care, 20.1% had less than 350 CD4 cells/\u3bcl, 87.6% received antiretroviral therapy, and among these, 62.4% had a CD4 cell count higher than 350 cells/\u3bcl. The overall estimated prevalence of individuals diagnosed and linked to care in 2012 in Italy was 0.16 per 100 residents (all ages). Adding the estimated proportion of undiagnosed people, the estimated HIV prevalence would range between 0.19 and 0.26 per 100 residents. In Italy, the majority of people diagnosed and linked to care receive antiretroviral therapy. A higher prevalence of individuals diagnosed and linked to care was observed in Northern Italy and among males. More information for developing the HIV care continuum is necessary to improve the entire engagement in care, focusing on test-and-treat strategies to substantially reduce the proportion of people still undiagnosed or with a detectable viral load