Stating the obvious – nurses: critical link to women and children affected by HIV/AIDS: a response to the revised WHO HIV treatment guidelines

Abstract

The WHO recently revised its global guidance on HIV prevention, care, and treatment. These guidelines form an integral part of a comprehensive approach to treatment and the prevention of vertical (i.e. mother-to-child) transmission of HIV. As nurses who work in President's Emergency Plan for AIDS Relief (PEPFAR) supported countries, we are advocates for the nurses who will be doing this work. A well informed, highly skilled nursing workforce should be a top priority for all national health systems. Although this is an accepted fact, unfortunately we are not seeing this in practice. Nurses are the largest cadre of healthcare workers, therefore critical that they are actively supported to translate these revised guidelines into practice as well as the most frequently cadre of workers who interact with women and children. The nursing community has made great strides in adjusting standards and practices to meet the ever-changing needs of our patients. In the USA, HIV programs are successfully utilizing a team approach to care, including nurses as key to the treatment team. In areas of health worker shortages, coupled with a high demand for services, national health systems have shifted some of the responsibilities of treatment to nurses. However, implementation of the new WHO guidelines will require that nurses once again incorporate a number of changes into their daily practice. Nurses have proven their ability to be leaders in HIV care and treatment in even the most challenging conditions; the authors offer some recommendations to aid proper engagement of nurses in the provision of client-centered HIV prevention, care, and treatment services in light of the WHO guidelines. Nursing faculty must gain a firm understanding of the new guidelines and ensure that their students are getting the practical information that they will need. Preservice education should also utilize a systems-based approach so that nurses are equipped to develop and run programs that will provide clients with consistent and continuous access to HIV-related services. This involves content on affecting health system change as well as the pharmacologic and physiological aspects of HIV. The WHO and program implementers should work with nursing organizations to look at gaps in current healthcare systems and make appropriate changes to link and integrate services so that women's and children's access to HIV treatment is not hindered by vertical or ‘siloed’ programs. HIV services should be delivered at the Antenatal Care (ANC) clinic to ensure pregnant woman receive timely care and treatment. This provides an opportunity to establish long-term relationships with HIV-positive mothers, which is correlated with good adherence to care and treatment for HIV-positive mothers and their HIV-exposed children. For a nurse, one way to accomplish this is from the HIV care and treatment program where she should work closely in ANC either through mentorship of the ANC staff, or preferably have a physical presence in ANC clinic at an interval that is based upon the volume. Cross-training of ANC and HIV service providers should be provided through in-service education and mentoring to promote a team approach to care. Nursing organizations, including the International Council of Nurses, should conduct advocacy at the national level to advocate that nurses receive the training they will need to implement the revised WHO guidelines. Mentorship initiatives should emphasize a team-based, collaborative approach to care. Management of HIV disease is complex not only because of antiretroviral treatment regimens, but also because of the psychological and social implications of the disease, especially in regard to stigma [1]. Understanding the training and support needs of those who touch the lives of women and children affected by HIV/AIDS daily – nurses, as well as clinical officers, midwives, physicians, and the community – will be critical to the successful implementation of the revised WHO guidelines. It is hoped that application of the recommendations offered here in regions of the world most deeply affected by HIV and AIDS will take us a step closer to securing optimum health for all those living with HIV, and will enhance global efforts to decrease mother-to-child HIV transmission and protect the health of mothers and children living with HIV. Nurses will continue to be on the front lines of care, and for the successful adoption of these guidelines, the voice of nursing needs to be sought out. Consider this quote from Bunesh and Gordon (2000) [2] (‘Envision how things would be if the voice and visibility of nursing were commensurate with the size and importance of nursing in healthcare; p. 11’) Affecting change needs this voice. Nurses are here to support the change.