Introduction

The Human Immunodeficiency Virus (HIV) is considered one of the leading causes of morbidity and mortality globally. The high rates of mortality associated with HIV have rendered this condition a global public health issue. Research studies on HIV and its treatment have improved the quality of care offered to individuals infected with this condition, making it a manageable chronic illness. Although it is mainly a sexually transmitted disease, HIV can also be transmitted through sharing needles or syringes, blood transfusion, other bodily fluids like pre-seminal or semen, and breast milk. Globally, governments have worked together in disseminating information about the conditions and ensuring that infected individuals have access to treatment and other healthcare services. Gaps in HIV knowledge in some communities, diagnostic kits, healthcare, and follow-up services continue to affect proper management of this condition, especially in marginalized communities. This paper seeks to assess the goals and objectives that the U.S. federal government created through the Healthy People 2020 plan for developing a healthier nation, review research studies conducted in support of the Healthy People2020 goals for HIV, and provide a description of a nursing role focused on achieving the goals.

Healthy People 2020

HIV is a global public health problem. With more than 77 million people having been infected globally, approximately 35 million people have died from this disease. As of January 2019, an estimated 36.9 million people were living with the disease  (Schwetz & Fauci, 2019). Approximately 1.8 million infections are reported annually, and more than one million people die each year due to HIV or complications related to the condition (Schwetz & Fauci, 2019). Since the 1980s, billions of dollars have been directed towards research studies aimed at understanding the nature of the virus, prevention strategies, treatment, and management of complications associated with HIV. The National Institutes of Health (NIH) is recognized as the largest financial contributor in HIV research. NIH invested approximately $69 billion between 1982 and 2018 (Schwetz & Fauci, 2019). The most impressive advances in HIV research was the identification of antiretroviral therapies as effective suppressants for the viral load in infected patients (Fajardo-Ortiz et al., 2017). The invention of antiretroviral therapy has enabled infected people to lead more comfortable lives.

The infection and progression of this virus occurs in five stages that include the acute infection stage, window period, asymptomatic, symptomatic, and full-blown AIDS stage, which is often followed by death. The virus enters the bloodstream and seeks out T-helper lymphocytes that regulate the immune response in the event of an infection or an attack by a bacteria or virus. The number of T-helper lymphocytes (T4 or CD4 cells) in the body determines the strength or weakness of the infection. A low CD4 cells count means that the HIV virus has affected the immune system severely, thereby increasing the risk of progression from HIV to its severe form, AIDs (Vijayan, Karthigeyan, Tripathi, & Hanna, 2017). Treatment plans focus on promoting the immunity system.

Some of the risk factors associated with HIV include sharing needles while injecting drugs among drug users, having unprotected sex with infected people, and breastfeeding a child by an infected mother. Individuals who have a cut or an open wound can also get infected by touching the blood or bodily fluid of an infected person. While blood transfusion initially posed a risk for transmitting HIV, blood transfusion centers have put in place assessment measures that ensure blood is tested for HIV and other conditions before transmission (Vijayan et al., 2017). The most common risk factor is sexual transmission.

One of the Healthy People 2020 goals associated with HIV is based on preventing HIV infections and risk of related illnesses or HIV-linked death. In the United States, the first case of this infection was reported in 1981, and the number of new infections increased rapidly during the 1980s and the early 1990s  (HealthyPeople.gov, 2020). A benchmark that is used in to determine whether the goal has been achieved is the assessment of the rates of new infections and mortality rates annually. In 2010, 43,809 people were diagnosed with HIV in the U.S.  (HealthyPeople.gov, 2020). The current diagnostic goal was based on reducing the number of new diagnosis to 32,855 persons  (HealthyPeople.gov, 2020). Some of the approaches put in place to achieve the goal included maintaining consistency with national guidelines, programs, policies, and regulations put in place for educating people about the virus, assessing, and treating infected individuals (HealthyPeople.gov, 2020). Continued adherence to these measures will ensure that the rates of new cases reduced.

Synthesis of Peer-Reviewed Articles

One of the peer-reviewed articles that related to the HP2020 HIV goal is a study on ending the HIV epidemic that focused on assessing the current measures being taken to address the HIV pandemic in the United States. The article addresses the “Ending the HIV Epidemic” initiative that was introduced by President Trump in 2019. The article addresses factors that can hasten the plans to end HIV such as selecting the right leadership techniques to address the problem and formulation of appropriate fundamental strategies. In 2019, the president allocated $291 million, through the “Ending HIV Epidemic” initiative, to fund the 2020 fiscal year plans for reducing the number of new HIV infections. The funds were projected to be used to reduce the number of new HIV infections by 75% in the next five years and by 90% in the next ten years  (Giroir, 2020). The funds released would be an addition to the current budget of $20 billion that is used by the government annually in prevention and management of HIV (Giroir, 2020). The funds would ensure that aspects of preventive measures that had not been addressed in the previous years were incorporated in the new budget.

The article addresses strategies that can be used to reduce the rates of HIV through the partnership of state and local health agencies’ leaders in expanding access to pre and post-infection drugs, quick response to outbreaks, and promotion of adherence to treatment among infected individual to ensure that their viral load and risk of transmission is reduced. Some of the fundamental strategies pointed out in the article, which can be used to promote the successful implementation of the plan, include the early diagnosis of infected individuals, rapid treatment of infected individuals to suppress their viral load, use PrEP and syringe service programs to prevent infections, and respond to outbreaks to prevent extensive transmission (Giroir, 2020). The researcher points out the importance of collaboration among organizations such as the CDC, NIH, and other national or state health agencies to ensure that the cross-agency initiative is successful.

The article’s content supports the HP2020 HIV goal through its focus on supporting the advancement of the HP2020 HIV goals in reducing the number of new infections. Since the HP2020 was developed to address health problems in the U.S. from 2010 to 2020, the article discusses measures that have been put in place to ensure that there will not be a fall out after the attainment of the HP2020 goals for HIV. By identifying the initiative put in place to further reduce the rates of HIV within the next five and ten years, as well as fundamental strategies that should be used to ensure that the initiative is successful, the content in the research promotes the goal towards ending HIV in the U.S. This research is applicable to the current practice through its suggestion of measures like quick management of outbreaks, proper use of pre and post-infection drugs, and diagnosis of individuals as early as possible to prevent further infections (Giroir, 2020). It supports measures put in place to reduce new infections.

The second study identified reviewed concepts related to the epidemiological management of the HIV epidemic and assessed the effectiveness of these measures in the past 35 years. The articles assessed the measures of disease control such as control, elimination, eradication, and extinction that have been used over time to assess the levels of success in managing HIV, the goals formulated for HIV management, transmission rates, mortality, and the current state of the country in controlling HIV. According to the article, the aspirational goal in eliminating the rates of infection through blood transfusion and mother-to-child methods have been effective when compared to management of sexual transmissions and those associated with sharing of needles among drug users. The article sensitizes the importance of promoting pre and post-infection drug use among individuals in relationships with infected partners, use of needle exchange programs, VMMS, and adherence to ARV therapies as a realistic way of preventing new transmissions (Jones, Sullivan, & Curran, 2019). The article is mainly focused on assessing previous trends based on epidemiological data and determining effective preventive mechanisms that can be used in the future.

The article’s content supports the HP2020 HIV goals through its assessment of approaches that have been put in place to address the HIV epidemic and use of measures of disease control to determine the epidemiological changes that have been witnessed over the years since the first case was reported. The researchers used this approach to determine areas of weaknesses that required addressing to ensure that the attainment of the goal aimed at reducing new cases. The study also points out new aspirational but feasible objectives, which are based on existing HIV management approaches, that can be used to control and eradicate HIV and HIV-related mortality such as managing stigma, promoting behavior change, promoting the use of ARVs, and offering breastfeeding mothers from low-income communities feasible alternatives for breast milk (Jones, Sullivan, & Curran, 2019). These measures support the HP2020 goal for HIV eradication.

In terms of applicability to current practice, this research sheds light on the relationship between the current HIV rates and factors that promote the continued rates of transmission. The study’s applicability is also based on its development of aspirational but feasible goals that can be used to promote the current measures put in place to prevent and manage HIV. The study also points out possible barriers that could affect the attainment of the aspirational goals to ensure that healthcare practitioners and agencies can implement the provisions of the goals successfully (Jones, Sullivan, & Curran, 2019). The researcher’s use of reliable data to track the progress of HIV management over the years also makes it a suitable point of reference that can be used to examine successful and unsuccessful HIV management techniques.

Nursing Role in Improving Population Outcomes in HIV Management and Prevention

One of the nursing roles focused on improving population outcomes in HIV management and prevention is patient advocacy. This role entails working as the link between patients diagnosed with HIV and other healthcare providers. Nurses perform this role by educating patients about their health condition, possible intervention plans, effects of the disease of their body, importance of treatment, and side effects of treatment that might be experienced. In promoting the HP2020 HIV goal, nurses can conduct this role by educating newly-diagnosed HIV patients about HIV and the importance of adhering to treatment as a way of suppressing their viral load and reducing their risks of transmitting the infection to other people. Nurses can also achieve the HP2020 goal for HIV by following up patients on ARV therapies to ensure that they adhere to their treatment and educating and assisting HIV-positive mothers to find alternatives for breast milk that would be suitable for their infants (Rouleau, Richard, Cote, Gagnon, & Pelletier, 2019). These patient advocacy measures are effective in promoting the attainment of the HP2020 goal for HIV.

Conclusion

The HP2020 goal for managing HIV focused on reducing the number of HIV infections by 2020 significantly and promoting effective management of related illnesses and death. The measures that have been put in place since the goal was set, which include encouraging people to get tested, dissemination of information related to HIV and its modes of transmission, and promoting the use of ARV therapies among infected populations, among other methods, have been effective in reducing the rates of HIV in the country. The studies reviewed in this paper offer insight on measures that have been implemented within the past few years to support the HP2020 goal in eradicating HIV. These research studies also shed light on aspirational but practical goals that can be put in place to support the HP2020 HIV goal and the barriers that healthcare practitioners and health agencies might face.

References

Fajardo-Ortiz, D., Lopez-Cervantes, M., Duran, L., Dumontier, M., Lara, M., Ochoa, H., & Castano, V. M. (2017). The emergence and evolution of the research fronts in HIV/AIDS research. PLOS ONE, 12(5), e0178293. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444800/.

Giroir, B. P. (2020). The Time Is Now to End the HIV Epidemic. American Journal of Public Health, 110(1), 22-24. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893354/.

HealthyPeople.gov. (2020). HIV. Retrieved from HealthyPeople.gov: https://www.healthypeople.gov/2020/topics-objectives/topic/hiv/objectives

Jones, J., Sullivan, P. S., & Curran, J. W. (2019). Progress in the HIV epidemic: Identifying goals and measuring success. PLOS| Medicine, 16(1), e1002729. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338352/.

Rouleau, G., Richard, L., Cote, J., Gagnon, M.-P., & Pelletier, J. (2019). Nursing Practice to Support People Living With HIV With Antiretroviral Therapy Adherence: A Qualitative Study. The Journal of the Association of Nurses in AIDS Care, 30(4), e20-e37. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594722/.

Schwetz, T. A., & Fauci, A. S. (2019). The Extended Impact of Human Immunodeficiency Virus/AIDS Research. The Journal of Infectious Diseases, 219(1), 6-9. Retrieved from https://academic.oup.com/jid/article/219/1/6/5063659.

Vijayan, K. K., Karthigeyan, K. P., Tripathi, S. P., & Hanna, L. E. (2017). Pathophysiology of CD4+ T-Cell Depletion in HIV-1 and HIV-2 Infections. Frontiers in Immunology, 8. 580. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440548/.