Acquired HIV Module 12 Zoom Activities 1 Multidisciplinary discussion Objective Explain the psychosocial and biomedical impact of perinatallyacquired HIV and explore interprofessional interventions to address these issues IPE ID: 1045391
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1. Care for the Adolescent Male with Perinatally-Acquired HIVModule 12 Zoom Activities
2. #1: Multidisciplinary discussion Objective: Explain the psychosocial and biomedical impact of perinatally-acquired HIV, and explore interprofessional interventions to address these issues (IPE)
3. John is a 17-year-old boy with perinatally-acquired HIV on TDF/3TC/DTG. His mother died when he was young. He recently found out that he was HIV-positive when he was hospitalized for 8 days with pneumonia. After sharing the news with his girlfriend, she broke up with him. Since then, his marks in school have been poor. He has not been taking his medications regularly, has self-medicated with substances, and has been depressed. His teacher referred him to the school nurse.Case
4. ImpactsInterventionsPsychosocial Illness and death of parents and siblings due to HIVResponsibility for welfare of younger siblings, ill family membersStigma and discriminationFear of being seen as abnormalConfronting an uncertain future, own mortalityAbsenteeism from school due to illness, appointmentsEconomic impact on familyDepression, anxiety, stress disorderRegular assessments of schooling, guardianship, bereavementScreen and treat for depressionCounsel caregivers Trainings for teachers on confidentiality and discrimination, and communication with caregiversTrainings for health-care workers on adolescent development and careAttention to autonomy and confidentiality of adolescents as patientsLinkage to community-based psychosocial support servicesBiomedical Opportunistic infectionsVaccine-preventable illnesses, e.g. measles, HPVPremature malignancies: B-cell & T-cell lymphoproliferative disorders, KSChronic lung diseaseCardiac disease: dilated cardiomyopathy, left ventricular dysfunction, etc.Growth failurePubertal delayEarly identification of HIV infected individuals with slow progressing disease: screening algorithms, community-based testingPromotion of retention in care and adherenceEarlier initiation of ART to prevent complicationsInterventions for lung and heart diseaseMonitoring for chronic complications and timely referralsImpact of and interventions for Perinatal HIV InfectionLowenthal ED et al. Lancet Infectious Diseases. 2014.
5. Breakout rooms 10 minutes
6. Reflection
7. #2: Effective communication role playObjective: Discuss strategies to address individual, familial, and health system barriers to retention in care and adherence to ART in adolescents with HIV.
8. In pairs, practice approaches to communicating effectively with adolescent patients. Switch roles after 5 minutes.Read the role play scenarios from: “Learner Zoom Handout” (PDF on the course site)Role Play instructions
9. Breakout rooms 10 minutes
10. ReflectionWhat were barriers to communication? What worked well?What could be improved upon?What attitudes or behaviors can help communicating with adolescent patients?
11. #3: SBAR PracticeObjective: Demonstrate how to refer a patient to a specialist for drug-resistant HIV (IPE)
12. SBARA communication tool/information exchange strategyA framework for team members to effectively communicate information to one anotherSITUATIONWhat is going on with the patient?BACKGROUNDWhat is the clinical background or context?ASSESSMENTWhat do you think the problem is?RECOMMENDATIONWhat would I recommend?
13. Example: SBAR Nurse-to-Physician ReportSITUATIONThis is a 65-year-old female who is complaining of new-onset chest pressure, and is pale, sweaty, and confused.BACKGROUNDShe has a history of HTN, was admitted for a GI bleed with last Hemoglobin stable at 9.7 yesterday. Blood pressure has now dropped to 90/50 and pulse increased to 120 (from 120/80 and 85 two hours ago)ASSESSMENTI think the patient has an active bleed but also can’t rule out a myocardial infarction.RECOMMENDATIONI’d like to get an EKG, CBC, and give the patient IV fluids. I’d also like for you to see her right away.
14. In pairs, practice approaches to communicating effectively with adolescent patients.Each person should practice for 5 minutes and then receive feedback from their partner for 2-3 minutes.You can find the SBAR framework in your “Learner Zoom Handout” (PDF on the course site)SBAR Practice
15. Breakout rooms 15 minutes
16. Debrief
17. SBAR Nurse-to-Physician ExampleSITUATIONIbrahim is a 13-year-old male with history of perinatally transmitted HIV with multidrug resistance on TDF/3TC/DTG now with poor adherence in the setting of multiple life stressors. BACKGROUNDIbrahim was perinatally infected and his mother is deceased. He had been taking meds as a child intermittently. He was hospitalized earlier this month x 8 days with pneumonia, and his HIV status was disclosed at that time. ASSESSMENTDisclosure of HIV status resulted in the end of a romantic relationship and subsequent manifestations of depression, poor school performance, new onset substance abuse, and sub-optimal medication adherence with detectable viremia. I have concern for evolving drug resistance. RECOMMENDATIONI am requesting expert HIV management consultation for ART regimen selection in the setting of multidrug resistance and new virologic breakthrough in the setting of poor adherence.