1. NURSETRI, Nursing role in HIV care : an overview Jane Bruton Clinical Research Nurse

2. NURSETRI Aim: To share experiences and learning To assist in the development of nursing and midwifery skills in caring for individuals with HIV To develop sustainable links with other nurses through exchanges and continued contact.

3. Estimated Global HIV statistics 35.6 million people living with HIV globally 2013 17.7 million women 2.1 million newly infected 2013 1.5 million deaths globally 2013 = reduction in new infections and deaths globally However..50% of people living with HIV don’t know their status

5. HIV and AIDS 2013 Romania Cumulative number people diagnosed with HIV since 1985 19,261 (of which 9,946 diagnosed as children) Adults aged 15 to 49 prevalence rate 20130.1% (% - 0.2%) Adults 15 and up living with HIV12,223 Adults 20 – 29 years old7,012 Children <14 years old202 New born7

6. Romania New diagnoses 2013 Majority heterosexual transmission 54.5% of all new cases IVDU’s 29.23% of all new cases (up from 3% in 2010) MSM maintained at 11.4% as previous 2 years Most new cases 35% registered between 20 – 24 years old and are late presenters

7. Treatment today Treatment to prevent transmission WHO treatment start at 500 EACS treatment start at 350 (consider at 500 in certain circumstances) Treatment to prevent HIV acquisition PREP PEP

8. Global treatment access 85% PLWHA eligible (WHO guidelines 2013) Almost 12 million have access to ARV’s 18 million no access

9. The challenge of universal access on nurses role Task shifting – resource poor countries Advanced practice – resource rich

10. The treatment continuum -ideal versus poor engagement in care Aware of diagnosis Linked to HIV Care Retained in HIV Care Fully engaged in HIV care Aware of HIV Not linked to care Aware of HIV Not linked to care Having other medical care not HIV care Linked to HIV care Lost to follow up Linked to HIV care Lost to follow up In and out of HIV care Unaware of diagnosis ART adherent Undetect -able VL ART adherent Undetect -able VL

11. Impact of psycho-social issues Stigma internal external Racism/Homophobia Poverty Housing instability Employment instability Substance use – drugs alcohol Coexisting conditions – mental health

12. Nurses role in…….. Testing Engagement in care Retention in care Maintaining an undetectable viral load

13. Testing Non-judgemental approach Indicator diseases Taking opportunities

14. Engagement in care Confidentiality Non-judgemental Assessment and review Support Nurse contact and follow up Education Advocacy Navigation

15. Retention in care Treatment support (including readiness to start assessment) Assessment and review Coordination Follow-up Sign posting

16. Undetectable viral load Adherence and treatment support

17. Aim of nurse meeting Cover all the key issues for nurses role in the continuum of HIV care Discuss the challenges and ask questions Share experiences and learn from each other Network And enjoy!