What is the epidemiologic triangle?
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Human Immunodeficiency Virus
Infections with the human immunodeficiency virus (HIV) results in a chronic life-threatening disease and over time may cause acquired immunodeficiency syndrome (AIDS). HIV is believed to have originated in Central Africa transmitted from chimpanzees to humans (CDC, 2017). As it spread globally from Africa, it is believed to have made its way into the United States (U.S.) in the mid 1970’s and was first reported to the CDC in 1981 (CDC, 2017). This paper will discuss the communicable disease, describe the determinants, discuss the factors, and explain the role of a Family Nurse Practitioner.
HIV is a virus that when contracted inserts itself into the hosts DNA and over time results in destruction of the body’s immune system. HIV is a bloodbourne pathogen spread from one person to another, by transfers of blood, semen, or vaginal fluid, most commonly but not exclusively limited to sexual intercourse. Other modes of transfer include IV drug use or work-related exposure. It can also be spread through childbirth and infected breast milk (Wade, 2015). According to Wade (2015), one in six persons do not know they are infected with the virus. “Transmission of HIV first results in an acute infection, followed by an asymptomatic period that averages ten years” (Wade, 2015). It remains dormant in the lymph nodes, liver and spleen. As patients become symptomatic, the immune system weakens and opportunistic infections can occur (Wade, 2015). Although there are 2 strains, HIV1 and HIV2, they are transmitted the same way and both can lead to AIDS. HIV targets CD4 T-cells, which are needed to fight infections.
Individuals diagnosed with HIV usually exhibit signs and symptoms of weight loss, fever, night sweats, and fatigue. Advanced signs of HIV are swollen lymph nodes and Kaposi’s sarcoma lesions, which are purplish blotches located on the skin or inside the mucous membranes of the mouth (Wade, 2015).
HIV complications vary from person to person. With the highly active antiretroviral therapy (HAART), there are fewer complications noted. Some complications that can occur are AIDS wasting syndrome, HIV-associated neurocognitive disorder, cancer, and opportunistic infections such as candida albicans, tuberculosis, and pneumocystis pneumonia (Wade, 2015).
Treatment for people infected with HIV is antiretroviral therapy (ART). It is necessary to find the right “cocktail” or mixture of ART’s, which is determined based on the individuals specific viral resistance profile. “Since its initial observation in 1981, acute HIV disease treatment has transformed from a single drug to the current 30 medications, allowing patients an improved life expectancy” (Orsega, 2015).
Great strides have been made with HIV, but statistically, it still is a major problem in the U.S. and globally. According to the CDC (2017), there were an estimated 37,600 new HIV infections in 2014. “There are an estimated 1.1 million people in the U.S. living with HIV at the end of 2015” (CDC, 2017). In 2016, 39,782 people received an HIV diagnosis. In 2014, 6,721 people have died from HIV and AIDS in the U.S. Although these numbers are high, there has been a decline in new diagnosis by 5% from 2011-2015 (CDC, 2017).
Social determinants such as poverty, IV drug use, lack of education, and income play a role in HIV infection and the people who are infected. The highest groups at risk are gay and bisexual men, accounting for 70% of all new diagnosis. When divided amongst ethnicity, African-Americans account for 44% of new diagnoses, Whites account for 26% and Hispanics/Latinos account for 25% (CDC, 2017). The highest average rates of HIV diagnoses were among whose who lived below the federal poverty level, who had less than a high school education, and who had an income less than $36,000 a year (CDC, 2017).
Host factors, agent factors, and environmental factors interact in ways that result in various states of health in an individual or a community. The host is defined as the organism that carries the disease and is affected by the agent. The agent is the microorganism that causes the disease and the environment includes outside factors that affect the spread of the disease (Engard, 2017). For HIV, the host is the human who is infected, the agent is the transmittable viral infection that targets a person’s immune system, and the environmental factors would be social norms, an individual’s average rate of sex partners, poverty, and discrimination to name a few (Engard, 2017).
Role of the Community Health FNP
All aspects of the healthcare community play a collaborative and multidisciplinary role in caring for HIV patients. As a nurse practitioner, a comprehensive health assessment including a physical examination should be conducted initially to determine the proper screening and testing. Serology diagnostic screening includes HIV antibody testing. If positive, CD4-T cell count, and viral load by PCR are then collected (Orsega, 2015). Although there is no cure, HIV can be well controlled with ART and patients who receive early and consistent treatment are able to live full and productive lives. The role of a family nurse practitioner (FNP) is to provide educational support, management, and guidance for patients living with HIV as well as to provide preventative measures to those individuals at risk for the disease. According to the CDC, patients who receive treatment and achieve an undetectable viral load have little to no risk of spreading the infection to other individuals (CDC, 2017). As such, it is the role of a FNP to appropriately screen patients at risk for the disease, make early diagnoses, and connect patient to treatment early in the disease process to help curb the HIV public health crisis. Furthermore, it is the role of the FNP, as a primary care provider, to educate at-risk patients of prevention measures including but not limited to safe sex practices, drug rehabilitation, and options for pre-exposure prophylaxis (PreEP) (CDC, 2017).
HIV can affect any sex, ethnicity, and age group. With proper medical management and individualized care, HIV can be controlled. With appropriate patient education, patients can make healthy choices and prevent disease. Additionally, once disease is identified, appropriate treatment is essential for the prevention of spread throughout the population. People with HIV can live full and high quality lives, but it takes a collaborative team approach to provide compassionate and effective care.
Centers for Disease Control and Prevention. (2017). HIV basics. Retrieved from https://www.cdc.gov/hiv/basics/
Engard, B. (2017). What is the epidemiologic triangle?. Retrieved from http://online.river.edu/epidemiologic-triangle/
Orsega, S. (2015). Adult HIV infection treatment update 2014: An approach to HIV infection management and antiretroviral treatment. Journal For Nurse Practitioners, 11(1), 95. doi:10.1016/j.nurpra.2014.10.034
Wade, P. (2015). Chapter 20: Nursing care of patients with HIV disease and AIDS. Understanding Medical Surgical Nursing, 5th ed (pp. 362-385). Philadelphia, Pennsylvania: F.A. Davis Company.