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Plenary: The Cascade of Care and Global Nursing Challenges
What have you done for me lately? Applications for the Cascade of Care
According to Joint United Nations Programme on HIV/AIDS (UNAIDS)
Executive Director Michel Sidibé, we have the tools at our disposal to reduce
HIV infection incidence, HIV-related morbidity, and disease-related
mortality. The UNAIDS global HIV targets of 90% diagnosed, 90% treated
with antiretroviral therapy (ART), and 90% viral suppression suggest that
testing and treatment are these tools. The format of the 90-90-90 targets
mirrors the HIV care cascade, placing the cascade at the center of the global
response to HIV. In addition, the association between HIV incidence and
viral suppression is a prime condition for HIV prevention, whIch must also be
considered. Scientists and clinicians around the globe expect the HIV care
cascade to guide interventions for HIV prevention and care and to measure
outcomes as we strive to achieve goals that will lead to the end of the HIV
epidemic.
Cascade of HIV Care – U.S. 2011
120%
100%
HIV
Diagnosed
Linked to
Care
20%
40%
37%
30%
Engaged in
Care
Prescrbed
ART
360,000
960,000
40%
80%
1.032 Million
60%
1.2 Million
80%
Bradley et al. (2014),
MMWR, 63.
444,000
86%
480,000
100%
0%
Living with
HIV
VL
Suppression
The HIV care cascade helps clinicians determine (a) the proportion of people
living with HIV (PLWH) who enjoy the clinical and epidemiologic benefits of
virologic suppression, (b) where interventions to reverse “drops” in the
cascade should occur, and (c) how success might be measured. We will
explore what the HIV Cascade of Care reveals for nursing innovation in
opportunities for leadership.
Challenged Health Systems: Global Nurses to the Rescue
Global health delivery challenges continue and efficient, effective, and
innovative systems are critical to provide safe and quality care. Systems are
vital to all health settings, particularly resource-limited settings in the United
States and around the world. Nurses are the key to the development,
implementation, evaluation, and constant re-tooling of systems but this
aspect of the nursing role is often lumped under the “patient care” umbrella
and nurses are not seen as change agents in this area. The lack of global
representation of nurses at key decision-making tables continue and our
patients, families, and communities are suffering. Fighting HIV has
illustrated where nurses have transformed health systems and the lessons
learned need to be applied to larger systems challenges.
By creating and fostering nurses as systems leaders, we can begin to
improve global health care delivery. Pre-service and continuing education
for nurses worldwide rarely provide building blocks needed to address
systems of care, but nurses learn these skills haphazardly and incompletely.
Examples of nurses as systems leaders from Partners In Health (PIH) sites, an
international non-governmental organization working in 10 countries, will
be shared to illustrate challenges and solutions.
Bibliography
American Organization of Nurse Executives. (2015). AONE Nurse Executive
Competencies: Population health. Retrieved from
http://www.aone.org/resources/nurse-leader-competencies.shtml
American Organization of Nurse Executives. (2016). System CNE White
Paper: The effective system nurse executive in contemporary health
systems: emerging competencies. Retrieved from
http://www.aone.org/resources/AONE%20System%20CNE%20White
%20Paper
Benton, D. (2012). Advocating globally to shape policy and strengthen
nursing’s influence. Online Journal of Issues in Nursing, 17(1),
Manuscript 5. doi:10.3912/OJIN.Vol17No01Man05
Gardner, E.M., McLees, M.P., Steiner, J.F., Del Rio, C., & Burman, W.J.
(2011). The spectrum of engagement in HIV care and its relevance to
test-and-treat strategies for prevention of HIV infection. Clinical
Infectious Disease, 52(6), 793–800.
Joint United Nations Programme on HIV/AIDS. (2014). 90-90-90 an
ambitious treatment target to help end the HIV epidemic. Retrieved
from http://www.unaids.org/en/resources/documents/2014/90-90-90
Obama, B. (2015). Executive order – HIV care continuum initiative 2013.
Retrieved from http://www.whitehouse.gov/the-pressoffice/2013/07/15/executive-order-hiv-care-continuum-initiative
Selanders, L., & Crane, P. (2012). The voice of Florence Nightingale on
advocacy. Online Journal of Issues in Nursing, 17(1), Manuscript 1.
doi:10.3912/OJIN.Vol17No01Man01
Sidibe, M., Zuniga, J.M., & Montaner, J. (2014). Leveraging HIV treatment to
end AIDS, stop new HIV infections, and avoid the cost of inaction.
Clinical Infectious Disease, 59(Suppl, 1), S3–S6.
Join us for the Cascade of Care and Global Nursing Challenges Plenary on
Saturday, November 12, featuring Sheila Davis and Lucy Bradley-Springer
Sheila Davis, DNP, ANP-BC, FAAN, and Chief Nursing Officer at Partners In
Health has worked in the field of HIV since the mid-1980s and in global
health since 2000. In 2004, she helped co-founded a non-profit that worked
on nursing and feeding programs in South Africa and Boston through 2010.
Davis is a frequent national speaker on global health, clinical topics, and the
role of nursing in human rights.
Lucy Bradley-Springer, PhD, RN, ACRN, FAAN, is an Associate Professor
Emerita at the University of Colorado Denver where she was the Principal
Investigator and Director of the Mountain Plains AIDS Education and
Training Center (1999-2015). She is the editor of the Journal of the
Association of Nurses in AIDS Care (JANAC), has worked in the area of HIV
since 1988, and has developed expertise in HIV prevention, retention in
care, and teaching healthcare providers about HIV.