Nursing strategies for working with key affected populations: summary

Nurses can play an important role in coordinating the care of individuals belonging to key affected groups and assisting them to navigate services. A holistic initial assessment is needed to identify issues that can potentially undermine an individual’s care. A multidisciplinary approach is important to support the most vulnerable to remain engaged in care.

At an individual level, assessment can include the following:

  • Educational needs regarding HIV treatment or prevention
  • Impact of the diagnosis or treatment on the life of the individual – including pregnancy, relationship issues
  • Sustainability of current accommodation settings and safety
  • Sustainability of income and access to financial assistance
  • Mental health and emotional needs
  • Access to tailored HIV services such as S100 providers
  • Disclosure of HIV status and its impact.

At an interpersonal level it may include:

  • Family and community connections
  • Social isolation
  • Social exclusion
  • Access to peer support.

Strategies that promote engagement include:

  • Non-discriminatory policies and procedures
  • Explicit commitment to confidentiality and support around HIV disclosure
  • Regular staff education including reflection on attitudes, consciousness-raising
  • Support for assertive outreach approaches
  • Nursing involvement in community development interventions and projects
  • Continuity of care by skilled and trusted providers[50]
  • Integrated clinical and community-based care (such as through liaison roles, care coordination roles, partnerships with community-based AIDS organisations).

Strategies found to be helpful in the international context include:

  • Strengths-based case management - clients are encouraged to identify their own abilities and skills to access resources and problem-solve.  This provides strong evidence for retention in HIV care
  • Peer navigation including peers as part of a health-care team
  • Reducing structural- and system-level barriers
  • Using community-based organisations as a setting for engaging persons with HIV Infection about the importance of regular care
  • Involving patients' significant others in retention in care interventions.[51]

Recently released guidelines suggest the following practices can improve linkage and retention in care:

  • Routine viral load testing 6 months and 12 months after starting on treatment, and every 12 months thereafter, if stable on treatment
  • Less frequent clinic visits for those on stable ART – every 3-6 months
  • ART can be distributed by trained, supervised lay providers
  • Programs should include community support interventions
  • Adolescent-friendly services.[52] [53]