This paper should clearly and comprehensively identify the disease or population health problem chosen. The problem must be an issue in your geographic area and a concern for the population you will serve upon graduation with your degree. The paper should be organized into the following sections:
1. Introduction with a clear presentation of the problem as well as significance and a scholarly overview of the paper. = HIGH RATES OF HIV/AIDS CASES IN BROWARD COUNTY, FL
2. Background of the disease including definition, description, signs and symptoms, and current incidence and/or prevalence statistics current state, local, and national statistics pertaining to the disease. (Include a table of incidence or prevalence rates by your geographic county, state, and national statistics.)
3. A review of current surveillance methods and any mandated reporting or methods for reporting the disease for providers.
4. Conduct descriptive epidemiology analysis of the disease including who is more frequently affected and characteristics of the population that might help in creating a prevention plan. Include costs (both financial and social) associated with the disease or problem.
5. Review how the disease is diagnosed, current national standards for screening or prevention, and pick one screening test and review its sensitivity, specificity, positive predictive value, cost and any current national guidelines for conducting which patients to conduct this test on.
6. Provide a brief plan of how you will address this epidemiological disease in your practice once you are finished with school. Provide three actions you will take along with how you will measure outcomes of your actions.
7. Conclude in a clear manner with a brief overview of key points of the entire disease,
Evaluation of Epidemiological Problem
The problem and significance- high HIV/ AIDS cases in Broward County, Fl
Every month, the department of health in Florida releases data related to the newly reported HIV/ AIDS cases in the entire state. A majority of the reports are organized using the counties breakdown. Broward County has for a long time been second to Miami-Dade as far as the infections are concerned. Between the January and the April of 2015, Broward County reported four hundred and three HIV infection cases (Tookes et al., 2015). Within this period in 2014, Klevens et al. (2016) noted that 328 cases had been tracked in Broward. Therefore, there was a 23% infections increase in 2015. During 2015’s first months, the county had reported one hundred and thirteen fewer cases, representing a 17% decrease compared to 2014 (136 cases) (Taveras, 2015). Taveras (2015) also indicated that by the close of April 2015, 18,317 people were believed to be living with the disease in Broward.
Background of the disease
Definition and description
AIDS is a potentially life-threatening, chronic disease that is caused by HIV. HIV interferes with the ability of the body to fight disease-causing organisms, therefore damaging the immune system. HIV is mostly transmitted sexually. It may also be spread through contact with blood that is infected, as well as from a mother to the child during childbirth, pregnancy, or breastfeeding. There is no cure for the disease (Collins, Friedland & Pickett, 2014). However, there are medications which dramatically slow down the disease’s progression.
Signs and symptoms
Two to four weeks following the infection, some people are likely to experience flu-like illness. Nonetheless, there are some who never feel sick during the stage. Some of the flu-like symptoms are mouth ulcers, swollen lymph nodes, fatigue, sore throat, muscle aches, night sweats, rash, chills, and fever (Collins, Friedland & Pickett, 2014). These symptoms might last from a number of days to weeks. Within this period, the infection never shows on the test but the people are highly infectious.
The signs and symptoms differ based on the stages that are acute/ primary infection, latency, and finally, AIDS. With the acute infection stage that lasts for a number of weeks, the symptoms are esophageal and mouth sores, malaise, rash, muscle pain, throat inflammation, swollen lymph nodes, and fever (Collins, Friedland & Pickett, 2014). During the latency stage, there are no or few symptoms, and it can last for two weeks to 20 years or more, based on the person. During the AIDS stage, there is a low CD4+ T cell count (less than two hundred per microliter), cancers, different opportunistic infections, and other conditions (Tookes et al., 2015).
Current prevalence and incidence statistics
In 2012, there were 18,030 people living with HIV/ AIDS in the county of Broward. In 2013, 804 new cases were diagnosed (Tookes et al., 2015). Moreover, in 2012, 249 people died from the disease (all-cause mortality). In 2012, 71% of the people suffering from the disease were men while 295 were women (Taveras, 2015). In the same year, 48% of those with the disease were black, 34% white, and 15% Latino or Hispanic (Tookes et al., 2015). Moreover, 62% of the HIV infections in men were as a result of gay sex, 5% injection drug use while 4% was from gay sex and injection drug use (Daniel-Ulloa et al., 2015). 73% of the cases in women during the same year could be traced back to heterosexual contact among women while 9% was because of injection drug use (Tookes et al., 2015).
Table of prevalence/ incidence rates by the geographic county, state, and national statistics
Fig. 1: A graph comparing HIV/AIDS infections in Florida and Broward in 2014
Current surveillance methods and mandated reporting for providers
Surveillance systems make use of the data related to HIV infection; implications resulting from activities such as voluntary counseling and testing, in addition to testing to screen donated blood or for diagnostic purposes (Daniel-Ulloa et al., 2015). Some of the objectives guiding the surveillance include assessing the epidemic’s magnitude, identifying most vulnerable or affected population segments, aid in resource allocation and policy formulation, and aid in prevention programs’ evaluation (Klevens et al., 2016).
After a healthcare provider realizes that a patient is positive, the testing site or clinic reports these results to the state health department, which then sends the information to CDC. If the partner-notification laws apply, the provider can inform the needle-sharing or sex partners. In some cases, the healthcare provider can inform a third party if there increased risk.
Descriptive epidemiology analysis
The frequently affected
HIV is transmitted through various bodily fluids including breast milk, vaginal fluids, rectal fluids, pre-seminal fluid, semen, and blood. People who engage in behaviors which ensure contact with the fluids are at risk. Some of these behaviors include having anal or vaginal sex without being on medications which treat or prevent HIV or without a condom, sharing injections and drug equipment with infected people, blood transfusion from an infected person, breast feeding, and mother to child transmission (Tookes et al., 2015). Sexually assaulted people are also at a high risk. People aged between thirteen and sixty four years are sexually active and, therefore, at risk. Some ethnic and racial groups such as African Americans, Latinos, Hispanics, and Asians are also at risk. Based on gender, women, the bisexual and gay men, as well as transgender people are at a higher risk. Other groups of people at high risk include the incarcerated, sex workers, healthcare workers, and the economically disadvantaged (Collins, Friedland & Pickett, 2014).
Characteristics of the population that can help in creating a prevention plan
Prevention plans are more viable in populations where infected mothers breastfeed without proper guidance; among the uneducated who lack information about different aspects of the disease; where drug abuse and sexual assaults are prevalent; high levels of sex workers and homosexuality; and where poverty is prevalent (Daniel-Ulloa et al., 2015). People engaging in these behaviors or activities are at a high risk of contracting the disease.
Social and financial costs linked to the disease
Considering that HIV/ AIDS is mostly prevalent among the poor people, the disease further imposes a fundamental financial burden on both families and patients. With the increasing accessibility and advent of antiretroviral therapy, the disease is presently acknowledged as a significantly chronic treatable condition with immense social and economic impacts. Direct costs are linked to monitoring, medications as well as medical care. There are also long-term financial costs where earnings are lost by the infected people who can no longer work. In addition, other members in the family have to chip in to promote efficient care provision (Collins, Friedland & Pickett, 2014).
HIV/ AIDS patients are isolated a lot and alienated in their communities, workplaces, and families. A lot of social stigma is connected to the disease, in addition to discrimination. The infected also suffer socially, mentally, and physically. The disease often results to breakups of families, particularly where one spouse was totally faithful, based on suspicion and mistrust (Daniel-Ulloa et al., 2015). The children from such families are also hurt emotionally, and this might affect their entire lives.
How the disease is diagnosed
HIV/ AIDS is diagnosed through HIV testing. Tookes et al. (2015) acknowledged that those unaware that they are infected mostly transmit a majority of the infections. There are different tests for the disease.
Current national standards for prevention or screening
CDC promotes the increased utilization of the intentional opt-out HIV screening, especially for patients aged between thirteen and sixty four years in all healthcare settings in which different other screening and diagnostic tests are performed routinely. All pregnant women should be tested (Taveras, 2015). Before the opt-out HIV screening is conducted, the patient should be informed about the intended HIV test, and he or she is permitted to defer or decline the test (Daniel-Ulloa et al., 2015). Based on CDC recommendations, the practitioners should first offer the patient specified information about the disease as well as offer a chance to defer or decline testing. The test results’ meaning should be discussed before and after the test.
A screening test
With a specificity of 99.9% and sensitivity of 99.9%, ELISA test is an excellent test. The positive predictive value of ELISA test is 91% (Daniel-Ulloa et al., 2015). As far as cost is concerned, the test is regarded as the least expensive and most effective. Other advantages include promoting accurate results. The test is also safe, simple to use, convenient, as well as superior in specificity and sensitivity. There are some national guidelines of the test. Patients are advised to be tested again after three months. The blood sample is normally tested for antibodies (Klevens et al., 2016). There can also be use of oral fluid, apart from saliva, that can be collected from the gums and cheeks. A urine sample might also be used, but is less accurate compared to an oral fluid or blood test. Confirmatory tests are also recommended after the test. The test can be performed on anyone willing to be tested, particularly those feeling that they have been exposed to viruses and other substances which might cause the infection. It can screen for both past and current infections (Taveras, 2015).
Plan for addressing the disease
HIV/ AIDS can be fought effectively through a testing and counseling campaign. The campaign can be developed with collaboration from different stakeholders including the government, private sector, and civil society (Taveras, 2015). This would go a long way in identifying and reaching many of the patients who require ARVs and reducing HIV infections. Regardless of the increased awareness creation including advocating for the use of condoms through mass media advertisements, HIV infection rate is rising, and the present generation is engaging in persistently risky behavior. Therefore, there is a great need to test and counsel people, considering that there are some people living with the disease but they are not yet aware. This campaign will involve having the healthcare providers take a prerogative of engaging their clients so that they are tested when attending the local healthcare facility for different services (Klevens et al., 2016). Before testing and counseling, the healthcare provider will have a role of explaining and reinforcing the significance of being aware about one’s status through being tested. This ideology focuses on the need of people to have a productive, long, and healthy life. The counseling will be founded on the idea that a single encounter with a HIV/ AIDS counselor lacks the power to totally transform the person’s behavior. Nonetheless, regular conversations around behavior in addition to an engagement with the person is without doubt valuable since it facilitates a change mindset that might affect future actions (Tookes et al., 2015).
One of the actions that should be promoted during the testing and counseling sessions is creating awareness on how HIV/ AIDS is spread as well as what people need to do to guard themselves from the disease. In addition to being offered the information face-to-face, the patients will be given pamphlets and brochures that they can use for future reference. They will be permitted to carry more brochures and pamphlets in case they have people they can give to. While providing the people with information as well as the interventions they can use to manage their health and prevent HIV transmission, it will also be necessary to fast-track those in need into the treatment program. Therefore, this will be the second activity or action (Taveras, 2015).
The third action is encouraging all those visiting their local healthcare institutions to be tested so that they can be aware of their status. This will be after raising awareness on the issues surrounding the disease and demystifying the social stigma often attached to the disease (Tookes et al., 2015).
Measuring the actions’ outcomes
The first action will be measured or evaluated by assessing the extent to which people visiting the local healthcare center are informed on the transmission and preventive approaches. Since people will be allowed to carry the pamphlets and brochures to their friends and family, it is expected that many more people than those who were attended to at the healthcare institutions will have acquired the information. Definitely, the informed will cease engaging in risky sexual behaviors and take the necessary preventive measures, which will lead to a reduction in the newly diagnosed HIV/ AIDS cases (Carey et al., 2015).
The second action will be measured through the number of people diagnosed with the disease during the testing and included in the treatment program. It is expected that there will be some infected people who were not aware of their status that will be identified. People with high needs will also be referred to other programs (Carey et al., 2015). Third, more people are expected to be tested voluntarily after being urged by the healthcare professionals and the need for regular testing emphasized.
From the foregoing discussion, it has been established that Broward County has a relatively high prevalence of HIV/AIDS. It has been established that male to male transmissions account for many of the new cases. Therefore, regular testing and counseling is recommended so that those infected can start receiving care and treatment as early as possible to avoid complications and slow down progression (Taveras, 2015). ELISA test is one of the screening methods that is highly accurate (Taveras, 2015). When implementing the campaign, carrying out regular evaluations would enable tracking progress and resource use. People should also be informed about the different aspects of the disease including the causes, signs and symptoms, need for regular testing and screening, proper prevention and managements, and the care that patients should receive. More specifically, preventive services should be emphasized on.
Carey, J. W., LaLota, M., Villamizar, K., McElroy, T., Wilson, M. M., Garcia, J., … & Flores, S. A. (2015). Using High-Impact HIV Prevention to Achieve the National HIV/AIDS Strategic Goals in Miami-Dade County, Florida: A Case Study. Journal of Public Health Management and Practice, 21(6), 584-593.
Collins, C., Friedland, B., & Pickett, J. (2014). A Rectal Revolution Takes a Village: Developing an Educational Video about Rectal Microbicides. AIDS research and human retroviruses, 30(S1), A94-A95.
Daniel-Ulloa, J., Ulibarri, M., Baquero, B., Sleeth, C., Harig, H., & Rhodes, S. D. (2015). Behavioral HIV Prevention Interventions Among Latinas in the US: A Systematic Review of the Evidence. Journal of Immigrant and Minority Health, 1-24.
Klevens, R. M., Jones, S. E., Ward, J. W., Holtzman, D., & Kann, L. (2016). Trends in Injection Drug Use Among High School Students, US, 1995–2013. American journal of preventive medicine, 50(1), 40-46.
Taveras, J. (2015). Integration of prevention, care and treatment in Broward County, Florida. In 143rd APHA Annual Meeting and Exposition (October 31-November 4, 2015). APHA.
Tookes, H., Diaz, C., Li, H., Khalid, R., & Doblecki-Lewis, S. (2015). A cost analysis of hospitalizations for infections related to injection drug use at a county safety-net hospital in Miami, Florida. PloS one, 10(6), e0129360.