Marie L. Talashek

A primary health care intervention to mobilize health workers for HIV prevention in Malawi

For the last 4 years we have implemented a model to mobilize rural health workers as leaders for HIV prevention in Malawi. We use a conceptual framework that integrates the World Health Organization’s (WHO) primary health care (PHC) model, the social‐ cognitive model of behavioural change, and contextual tailoring of the intervention. Health workers are potential rural HIV prevention leaders because they have community trust and respect. However, their leadership potential has been limited by both health system barriers such as inadequate workers, supplies, and training and personal barriers such as risky occupational and personal behaviours. In the first phase of the project, we developed collaborative relationships and conducted qualitative research to adapt a peer group intervention for rural health workers and community members. In the ongoing second phase, we trained the health workers, who then volunteered and provided the intervention to adults in the communities their health centres serve. The intervention was adapted for young people through a community participatory process. Currently the adapted intervention is being offered to young people. As a guide to replication, we discuss barriers encountered in implementing this collaborative project and how we overcame them. This project demonstrates that health workers can be effective leaders for community AIDS prevention in African countries. The primary health care model offers a feasible, cost-effective and sustainable approach to maximizing health worker-community collaboration to reduce the spread of HIV.

SEXUALLY TRANSMITTED DISEASES IN THE ELDERLY ISSUES AND RECOMMENDATIONS

The incidence of sexually transmitted disease (STD) in the elderly population is significant for both newly acquired disease and for residual complications from preceding infections. Every health-care practitioner needs to assume responsibility for the primary prevention of STDs, which focuses on avoiding infection. Primary health education is imperative in the presence of an escalation of sexually transmitted infection for which there is no known curative therapy. The sexual history is an integral component of the routine data base for all geriatric patients. Diagnosis of AIDS in the generally low risk elderly population may be unexpected. Health-care practitioners must be aware of its many forms of presentation.

Family Nurse Practitioner Clinical Competencies in Alcohol and Substance Use

&NA; The prevalence of substance use among patients presenting to primary health care settings mandates clinical competency in the area for nurse practitioners (NPs). An educational intervention with an evaluation component is described. The effect of incorporating substance use content into a Family Nurse Practitioner (FNP) curriculum was tested with a convenience sample of 16 FNP students and 8 practicing NPs. Students’ knowledge increased significantly; however, differences in students’ and practicing NPs’ knowledge did not reach significance. Students’ clinical competency increased significantly, as demonstrated by standardized patient clinical evaluations, and was significantly better than the practicing NPs in the skill domains of evaluation and record keeping. Educational intervention can improve NP identification of substance‐abusing patients in primary health care settings.

Chemotherapy: How safe for caregiver?

Antineoplastic drugs are routinely administered by nurses in the home setting. The potential for nurse occupational exposure to these drugs is increased by an inadequate understanding of the risks inherent in administering these agents. This article addresses issues related to safe administration of these drugs in a home environment.