HIV pre‐exposure prophylaxis uptake by advanced practice nurses: Interplay of agency, community and attitudinal factors. (30th July 2019)

• Record Type: Journal Article
• Authors: Jayawardene, Wasantha; Carter, Gregory; Agley, Jon; Meyerson, Beth; Garcia, Justin R.; Miller, Wendy
• Is Part Of: Journal of advanced nursing. Volume 75:Number 11(2019)
• Page Start: 2559
• Page End: 2569
• Publication Date: 2019-07-30
• Subjects: advanced practice nursing -- community‐institutional relations -- evidence‐based practice -- HIV -- pre‐exposure prophylaxis -- risk evaluation and mitigation; Nursing -- Periodicals; 610.7305
• DOI: 10.1111/jan.14019
• Languages: English
• ISSNs: 0309-2402

Abstract

Abstract: Aims: To identify associations among agency, community, personal and attitudinal factors that affect advanced practice nurses' uptake of HIV pre‐exposure prophylaxis, an intervention consists of emtricitabine/tenofovir once‐daily pill, along with sexual risk reduction education. Design: Cross‐sectional. Methods: During March‐May 2017, randomly selected Indiana advanced practice nurses were invited to complete an online survey, consisted of several validated self‐rating measures ( N = 1, 358; response = 32.3%). Final sample ( N = 369) was predominantly White, non‐Hispanic, female advanced practice nurses in urban practices (mean age = 46). Conceptual model for structural equation model included 29 original/composite variables and five latent factors. Results: Final model consisted of 11 variables and four factors: agency, community, HIV prevention practices (including screening) and motivation to adopt evidence‐based practices overall. Community had direct effects on HIV prevention practices (estimate = 0.28) and agency (estimate = 0.29). Agency had direct effects on HIV prevention practices (estimate = 0.74) and motivation to adopt evidence‐based practices (estimate = 0.24). Community had indirect effects, through agency, on the two remaining factors. Conclusion: Barriers exist against pre‐exposure prophylaxis implementation, although practice guidelines are available. HIV prevention practices must be integrated across organizational structures, especially in high‐risk communities, whereas practice change is more effective when focused on changing providers' attitudes towards intervention. When planning a pre‐exposure prophylaxis intervention, advancing inputs from healthcare professionals, organizational leadership and community members, is crucial to success. Impact: In settings where advanced practice nurses are primary contact points for health care, they may be best positioned to have an impact on implementation of HIV risk reduction strategies. Further research is needed to optimize their contributions to pre‐exposure prophylaxis implementation. Abstract : 目的: 在于确定机构、社区、个人和态度因素之间影响高级执业护士理解艾滋病接触前预防的关联, 干预措施包括每日一次的恩曲他滨/替诺福韦药丸, 以及性风险防范教育。 设计: 横截面。 方法: 在2017年3月至5月期间, 邀请了随机选择的印第安纳高级执业护士来完成一项在线调查, 该调查包括几项经过验证的自我评估数值(人数:1, 358;响应率= 32.3%)。最终试样(369名)主要是在城市里工作的白人、非西班牙裔女性高级执业护士(平均年龄= 46岁)。结构方程模型的概念模式包括29个原始/复合变量和5个潜在因素。 结果: 最终模型由11个变量和4个因素组成:机构、社区、艾滋病预防做法(包括筛查)和总体上采取循证实践的动机。社区对艾滋病预防措施(估值= 0.28)和机构(估值= 0.29)有直接影响。机构对艾滋病预防措施(估值= 0.74)和采取循证实践的动机(估值= 0.24)有直接影响。社区通过机构对其余两个因素产生间接影响。 结论: 尽管有实践指南, 但接触前预防措施的实施仍存在障碍。艾滋病预防措施必须进行跨组织结构整合, 特别是在高风险社区, 而措施变革在侧重于改变提供者对干预措施的态度时更为有效。在规划接触前预防干预措施时, 加大对医疗保健专业人员、机构领导层和社区成员的投入对成功至关重要。 影响: 当高级执业护士是医疗保健的主要联系人时, 可能他们才是对实施艾滋病风险防范战略产生影响的最佳人选。需要进一步的研究来优化他们对接触前预防实施的贡献度。