HIV-Related Content in Physical Therapist Education Programs: A Curricular Needs Assessment

Abstract

INTRODUCTIONOver the past 30 years, the development of antiretroviral therapy has drastically extended the life-span of people living with HIV (PLH). Because of this increased longevity, HIV is becoming a chronic disease; with proper treatment, PLH can have a life expectancy similar to that of their counterparts who are HIV negative.1 Therefore, the management of HIV has shifted to addressing the chronic systemic effects of the disease, such as musculoskeletal, neurological, and chronic pain issues. Mitigation of these effects requires a multidisciplinary approach to management of HIV-related impairments/, with an increasing role for physical therapists in the continuum of care for PLH.In an effort to enhance the use of physical therapy as part of the medical management of HIV, a 3-phase initiative was developed to analyze the current role of physical therapy in the HIV health care spectrum. Phase 1 assessed patterns of referral for physical therapist services made by physicians specializing in HIV management in Atlanta, Georgia, a city with a high prevalence of PLH. The results revealed that although most providers did refer their patients for physical therapist services, 30% of providers did not do so; the most commonly cited reasons were a lack of patient insurance, a denial of service by the clinics to which the patients were referred, and patient financial burdens.2 Phase 2 evaluated the knowledge and beliefs about HIV of 129 physical therapists practicing in the metropolitan Atlanta area. The results revealed that although most (65.1%) of the physical therapists surveyed reported their basic knowledge about HIV as advanced or competent, less than one-third of the respondents could correctly identify all methods of HIV transmission. Only half reported that learning best practices for treatments of HIV-related impairments was included in their physical therapist education.3On the basis of these results, this study (phase 3) was created to determine any potential gaps in HIV coverage in accredited physical therapist education programs throughout the United States. The aims of this study were to answer 3 questions: What percentage of physical therapist education programs cover HIV in their curricula? In what contexts is HIV covered (eg, pathophysiology, common physical therapy-treatable impairments, and interventions) in the programs surveyed? What needed teaching materials related to the inclusion of HIV are identified by surveyed faculty?REVIEW OF LITERATUREHuman immunodeficiency virus is a retrovirus that targets CD4+ T cells, reducing the human body's innate ability to fight off infections. The virus is spread through 4 specific bodily fluids (blood, semen, vaginal fluids, and breast milk). Seroconversion from HIV to AIDS occurs when the CD4+ cell count drops below 200/mm3, rendering a person more prone to opportunistic infections, such as tuberculosis, pneumonia, and lymphomas.4,5 In 2010, the Centers for Disease Control and Prevention estimated that in the United States alone, there were approximately 1.2 million PLH, and approximately 50,000 people continue to become infected with HIV each year.6,7 Because of the development of antiretroviral therapy for diminishing the immunosuppressive effects of HIV, the healthadjusted life expectancy-that is, the average number of years an individual is expected to live, with consideration of any disease or injury-has been extended for PLH.4,8-10A deterioration in physical function secondary to musculoskeletal, neurological, and cardiopulmonary impairments can be a consequence of chronic infection and systemic effects of antiretroviral therapy in PLH, leading to a significant decline in quality of life.11-13 These impairments fall within the scope of physical therapist practice. Musculoskeletal impairments secondary to deficits in bone remodeling and bone metabolism include myalgia, arthralgia, low back pain, osteoporosis, bone infection, and an increased risk for fractures. …