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Background: Monitoring the quality of human immunodeficiency virus (HIV) care and evaluating the effectiveness of HIV case management programs (CMPs) as approaches to raising the rate of HIV care retention and to improving the efficacy of viral suppression after the initiation of highly active antiretroviral therapy (HAART) are important focuses of research worldwide. Purpose: This study describes the trends and evaluates the influence of CMPs on retention in care and viral suppression among patients in Taiwan diagnosed with HIV from 2008 to 2010. Methods: This retrospective study enrolled 1,302 HIV-positive individuals who had visited at least one outpatient clinic between 2008 and 2012. Of these patients, 715 (54.9%) were enrolled in an HIV CMP. Trend analysis and logistic regression were applied to investigate longitudinal trends and the impact of CMPs on the quality of HIV care. Results: Retention in care improved substantially from 44.5% in 2008 to 57.3% in 2012. The percentage of viral suppression within 12 months of the initiation of HAART increased from 88.4% in 2008 to 93.5% in 2012. Of the patients who were in HIV CMPs, 73.6% were retained in care, which was significantly higher than the 31.7% among those who were not enrolled in CMPs (p < .001). Among the patients who received HAART for more than 180 days, those who achieved viral suppression within 12 months were significantly more likely to be retained in care (adjusted odds ratio = 5.36, 95% CI = 2.6-10.9, p < .001). Conclusions and Implications for Practice: Nurse-led case management programs play a role in improving HIV-related health outcomes. HIV CMPs are beneficial to HIV-infected patients by improving retention in care and are indirectly associated with successful viral suppression. [ABSTRACT FROM AUTHOR]

Family members play an important role in the process of writing advance directives. Homosexual men infected with HIV often wish to authorize their intimate same-sex partner or friends rather than immediate family members to make medical decisions on their behalf. Although same-sex marriage is currently illegal in Taiwan, HIV infected homosexual patients are able to write advance directives appointing their same-sex partner to be their surrogate decision maker for end-of-life medical decisions. This case report describes an experience assisting a homosexual patient with HIV to write his advance directives. The nurse assisted the patient and his partner to make a self-determined decision not to resuscitate. Family conferences held to discuss the patient's decisions regarding resuscitation helped legitimize his partner's primary role in making end-of-life healthcare decisions on his behalf. As an advocate for patient rights, nurses should understand the law as it relates to homosexuality and end-of-life decision making, inform patients on the durable power of autonomy, and help execute their advance directives. [ABSTRACT FROM AUTHOR]

Background: People living with HIV (human immunodeficiency virus) are at a high risk of depressive symptoms attributed to disease progression and HIV-related stress. While depressive symptoms are difficult to detect, in HIV patients they may negatively impact upon quality of life, decrease adherence to antiretroviral therapies, and further exacerbate disease progression. Purpose: Study purposes were to: (1) explore relationships among immune function indicators, perceived stress, social stigma and depressive symptoms and (2) identify depressive symptom indicators in HIV patients. Methods: Researchers recruited a total of 160 participants from infectious disease outpatient clinics at a university hospital in southern Taiwan. Chart reviews and four self-administered questionnaires (Beck Depression Inventory-II (BDI-II), Perceived Stress Scale, Multidimensional Scale of Perceived Social Support, and Social Impact Scale) were used to collect data. Results: Symptoms of depression (BDI ≥ 14) were observed in 68 (42.5%) patients and symptoms of major depression (BDI ≥ 29) in 25 (15.6%). We found immune function indicators negatively associated with depressive symptoms (p < .05) and perceived stress and social stigma positively associated with depressive symptoms (p < .01). Stepwise multiple regression analysis indicated that perceived stress and social stigma accounted for 44.4% of depressive symptom variance. Conclusion: Findings suggest that reducing perceived stress and social stigma may positively affect perceived depressive symptoms in this population and may be referenced in future development of related interventions. [ABSTRACT FROM AUTHOR]