Description
Benchmark Assignment: Epidemiology Paper
Communicable Disease Selection
Choose one communicable disease from the following list:
HIV
Epidemiology Paper Requirements
Include the following in your assignment:
Description of the communicable disease
This paper will describe the communicable disease, Human immunodeficiency virus, commonly known as HIV. This description will include causes, symptoms, mode of transmission, complications, treatment, demographic of interest, mortality, morbidity, incidence, and prevalence of HIV. The determinants of health will be described in the areas of lifestyle, genetics, environment, and social determinants. The epidemiologic triangle will cover the host, agent, and environmental factors of HIV. In conclusion, the role of the community health nurse and one national organization that contributes to resolving or reducing the impact of HIV will be discussed.
Human immunodeficiency virus (HIV) is an immunodeficiency disorder resulting in defective immune functioning (Copstead-Kirkhorn 264). CD4+ or T-helper/inducer lymphocytes act as a mediator between antigen-presenting cells and other immune cells, such as B cells and other T cells (Copstead-Kirkhorn 264). A defective cell-mediated immunity is the hallmark of an HIV infection, especially a decrease in their CD4+ count (Copstead-Kirkhorn 264).
Causes The retroviruses, HIV type 1 and HIV type 2 that primarily infect CD4+ lymphocytes and macrophages are the cause of HIV infection (Copstead-Kirkhorn 264). The primary causative virus infecting people in Central Africa, the United States, Europe, and Australia is HIV-1 (Copstead-Kirkhorn 232).
Symptoms. HIV infection affects all body systems; Early manifestations include fever, chills, headaches, nausea, vomiting, diarrhea, fatigue, weakness, arthralgia, sore throat, stiff neck, photophobia, irritability, and rash (Copstead-Kirkhorn 246). Malnutrition or wasting is the most significant symptom secondary to an elevated metabolic rate, chronic inflammation, malabsorption, anorexia, and multiple opportunistic infections (Copstead-Kirkhorn 246). HIV is known as “slim disease” in Africa because of this wasting (Copstead-Kirkhorn 246). GI symptoms are frequent and include diarrhea caused by Cryptosporidium or other agents, ulceration, candidiasis, and multiple other opportunistic infections (Copstead-Kirkhorn 251).
Opportunistic pneumonias, tuberculosis, and adult respiratory distress syndrome are among the pulmonary symptoms experienced with HIV infection (Copstead-Kirkhorn 251). Mucocutaneous symptoms may be allergic; infectious, such as candidiasis, herpes or Epstein-Barr virus; or neoplastic, such as Kaposi sarcoma (Copstead-Kirkhorn 251). Peripheral neuropathy, encephalopathy with dementia, headache, apathy, and focal deficits are neurological manifestation seen in HIV patients (Copstead-Kirkhorn 251). In HIV women persistent monilial vaginitis, cervical dysplasia, and pelvic inflammatory disease may be present (Copstead-Kirkhorn 251). HIV-associated retinopathy, CMV retinitis, malignancy, and a variety of ocular infections may be present (Copstead-Kirkhorn 251). In children, HIV infection causes problems with physical growth, intellectual development, and motor functioning (Copstead-Kirkhorn 251).
Mode of transmission. Primarily, HIV is acquired through sexual transmission via semen and vaginal and cervical secretions (Copstead-Kirkhorn 232). HIV can be transmitted parenteral via blood, blood products, and contaminated needles or syringes (Copstead-Kirkhorn 232). Also, HIV can be transmitted perinatal from a HIV positive mother to her infant antepartum, intrapartum, and postpartum via breast milk (Copstead-Kirkhorn 232).
Complications. HIV patients are highly susceptible to numerous complications because of their weakened immune systems. This includes Wasting syndrome, Neurological complications, kidney disease and infections such as Tuberculosis (TB), Cytomegalovirus (CMV), Candidiasis, Cryptococcal meningitis, Toxoplasmosis, and Cryptosporidiosis (MAYO). Other complications include cancers such as Kaposi’s sarcoma and Lymphomas (MAYO).
Treatment. There is no cure for HIV therefore treatment is focused on delaying the disease progress, restoring or preserving immunological function, suppressing plasma HIV viral load, minimizing clinical manifestation, reducing morbidity, prolonging survival, and preventing HIV transmission (Copstead-Kirkhorn 251). Polydrug therapy is used to treat HIV and includes antiretroviral therapy (ART) or highly active antiretroviral therapy (HAART) for better viral suppression which decreases viral load, increases CD4+ counts, and decreases resistance for longer periods (Copstead-Kirkhorn 251). In addition to ART or HAART therapy, aggressive treatment of opportunistic infections with appropriate antibiotics and antivirals is a big part of the treatment regimen (Copstead-Kirkhorn 251).
Demographic of interest. Sub-Saharan Africa had the highest rate of HIV population worldwide in 2014. Other regions with significantly high populations include: Asia and the Pacific; Latin America and the Caribbean; and Eastern Europe and Central Asia (CDC, 2015). In the United States about 50,000 people contract HIV yearly (CDC, 2015).
Mortality. “HIV is the leading cause of death worldwide and the number one cause of death in Africa,” (GLOBAL). In 2013, the World Health Organization (WHO) reported 1.5 million people died from HIV worldwide (WHO). However, this number is statistically better than previous years and puts the world on track to reducing the number of people dying from HIV by 25% by 2015 (WHO). The Global Health Policy reported 1.2 million deaths in 2014, which was a 42% decrease since 2004 (GLOBAL). This decrease is credited to the use of ART and HAART therapy. In children, growth failure is indicative of poor outcomes and mortality (Copstead-Kirkhorn 246). WHO reported in 2013 the deaths in children younger than 15 years old had reduced by 31% from 2009 and 40% from 2005 (WHO).
Morbidity. Homosexual and bisexual men, intravenous drug users who share needles or syringes, sexual partners of those in high risk groups, and infants born to infected mothers are at the greatest risk of acquiring HIV infection (Copstead-Kirkhorn 232). Nearly half of HIV infected patients do not know they have the virus (GLOBAL).
Incidence. Globally, a decline of 35% of new infections has been seen since 2000 (GLOBAL). In 2015 about 2 million new infections were diagnosed, which is about 5,600 new infections daily worldwide (GLOBAL). HIV is one of the leading causes of death among women of reproductive age; women represent approximately 51% of the HIV population (GLOBAL).
Prevalence. According to the Global Health Policy there were 36.9 million people living with HIV in 2014, which was an increase from 29.8 million in 2001 (GLOBAL). This increase is speculated to be from people living longer with HIV, new infections being reported, and general population growth (GLOBAL). In 2014, the global prevalence rate of people ages 15-49 years old diagnosed with HIV was 0.8% since 2001 where it started to level off (GLOBAL). In 2014, 2.6 million children were living with HIV worldwide (GLOBAL).
Describe the determinants of health and explain how those factors contribute to the development of this disease.
SEE SOCIAL DETERMINANTS OF HEALTH ON WEBSITE
Determinants of Health. The determinants of health include lifestyle, genetics, and the environment (Maurer & Smith, 2013 p. 468).
Lifestyle. Working, playing, eating, sleeping, and communicating describes a person’s lifestyle (Maurer & Smith, 2013 p. 468). The family has a major role in how a person develops their health beliefs and behaviors, such as exercising, eating healthy, safety awareness, avoiding harmful substances, stress management, and preventive primary care (Maurer & Smith, 2013 p. 468). When people live a careless lifestyle of unsafe sex practices and IV drug use, their lifestyle choices are exposing them to a higher risk of contracting HIV. Alternative lifestyle choices increase their risk of contracting HIV through homosexuality of unprotected sex.
Genetics. Illness related to genetics may be influenced by cultural and environmental factors, unlike familial diseases such as diabetes and heart disease (Maurer & Smith, 2013 p. 469). There is no genetic component linked to the HIV disease process, but genetic intervention is used in containing or treating the disease (WHO 2015).
Environment. Weather and climatic conditions, noise, light, air, food, water, and exposure to toxic substances are influences of health in the physical environment (Maurer & Smith, 2013 p. 469). IV drug users exposure their physical environment increasing their risk of contracting HIV.
Sociocultural environment includes the values of family and significant other, social institutions, occupation, socioeconomic class, social roles, and the historic era in which the person lives (Maurer & Smith, 2013 p. 469). Those of lower socioeconomic status may not have the resources or education to know how to prevent themselves from contracting HIV. Higher education and socioeconomic class is associated with greater participation in health-promotion activities (Maurer & Smith, 2013 p. 469). “Access to care also impacts the prevention of disease and the early detection of health conditions leading to a better quality of life and improves life expectancy,” (Maurer & Smith, 2013 p. 469).
Social Determinants. The social determinants of health include: economic stability; education; health and health care; neighborhood and built environment; and social and community context. Society-level influences include: policies such as providing access to health care; encouraging HIV testing; syringe service programs; cultural and societal norms, such as stigma, discrimination, women’s status in society, homophobia, and resilience of gay community (Harrison 2010). Psychosocial factors related to teen sexual behavior include: knowledge about STD/HIV transmission and method of protection, personal values about adolescents having sex, attitudes about condoms and contraception, perception of peer norms or family values about sex and condoms or contraception, self-efficacy to refuse unwanted sex or to insist on condom or contraceptive use and skills in communication, decision-making, negotiation, and refusal (Harrison 2010)
Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. (The textbook describes each element of the epidemiologic triangle).
Host Factors
Demographic characteristics:
Age
Youth aged 13 to 24 accounted for an estimated 26% of all new HIV infections in the United States in 2010 (CDC 2015).
Most new HIV infections among youth occur among gay and bisexual males; there was a 22% increase in estimated new infections in this group from 2008 to 2010 (CDC 2015).
Over 50% of youth with HIV in the United States do not know they are infected (CDC 2015).
People aged 50 and older have many of the same HIV risk factors as younger people, but may be less aware of their risk (CDC 2015).
People aged 55 and older accounted for one-quarter of all Americans living with HIV in 2012 (CDC 2015).
Older Americans are more likely to be diagnosed with HIV infection later in the course of their disease (CDC 2015).
Sex
Men accounted for 76% of all adults and adolescents living with HIV infection at the end of 2010 in the United States (CDC 2015).
Approximately one in four people living with HIV infection in the United States are women (CDC 2015).
Most new HIV infections in women are from heterosexual contact (84%) (CDC 2015).
An estimated 88% of women who are living with HIV are diagnosed, but only 32% have the virus under control (CDC 2015).
Transgender women are at high risk for HIV infection (CDC 2015).
Race/Ethnic background
Black/African American (CDC 2015)
Transgender women have the highest percentage of new HIV-positive test results.
Among all gay and bisexual men, African Americans are the racial/ethnic group most affected by HIV.
most affected by HIV.
The rate of new HIV infection in African Americans is 8 times that of whites based on population size.
Gay and bisexual men account for most new infections among African Americans; young gay and bisexual men aged 13 to 24 are the most affected of this group.
American Indians/Alaska Natives (CDC 2015)
had the highest percentages of diagnosed HIV infections due to injection drug use.
Native Hawaiians and Other Pacific Islanders(CDC 2015)
HIV affects NHOPI in ways that are not always apparent because of their small population size.
One in four unaware of their infection.
Hispanics/Latinos (CDC 2015)
7 in 10 new HIV diagnoses occur in gay and bisexual men.
Less than half are receiving medicines to treat their infection.
Asians (CDC 2015)
The number of HIV diagnoses has increased in recent years, along with the growth of the Asian population in the United States.
gay and bisexual men are most affected by HIV.
More than 1 in 5 Asians living with HIV do not know they have it.
Marital status
Men who have sex with men account for most new and existing HIV infections among men (CDC 2015)
Gay and bisexual men are more severely affected by HIV than any other group in the United States (CDC 2015)
From 2008 to 2010, HIV infections among young black/African American gay and bisexual men increased 20% (CDC 2015)
Young African American gay and bisexual men accounted for the highest number of new HIV infections in 2010 among all gay and bisexual men (CDC 2015)
Religion
Cultural taboos on talking about sex may interfere with HIV prevention for Native Hawaiians and Other Pacific Islanders (CDC 2015)
Education
According to the HIV surveillance report of 2005-2009, residents with less than a high school education had the highest average rates of HIV (CDC 2013).
Economic status
American Indians/Alaska Natives face HIV prevention challenges, including poverty, high rates of STIs, and stigma (CDC 2015).
HIV is a serious health issue in the incarcerated population, however most inmates got the virus before entering the correctional facility, but had never been tested until they were incarcerated as part of the admission procedures (CDC 2015).
Sex workers are at high risk of HIV and other sexually transmitted infections, but is difficult for them to seek care or prevention because of their economic status of living in poverty and they are engaging in sexual activity for income, employment, or non-monetary items, such as food, drugs, and shelter (CDC 2015).
People living in urban United States in poverty have the same HIV prevalence rate as people living in Burundi, Ethiopia, Angola, and Haiti (CDC 2015).
Level of health: HIV does not have a limit on age, race, or health status of an individual (Copstead-Kirkhorn 254).
Body defenses: The RNA virus in HIV primarily infects the body’s immune system thus destroying the body’s one basic foundation of defense (COPSTEAD 254). T
State of immunity: Because the HIV strain is variable and mutation is frequent, vaccine-conferred active immunity has been unsuccessful in all vaccine trials to date (Copstead-Kirkhorn 253-254).
Human behavior: In order to decrease the risk of HIV infection, safe sex and parenteral practices must be done (Copstead-Kirkhorn 232).
Agent Factors. The agent factor for HIV in the epidemiologic triangle is biological. HIV is caused by HIV types 1 and 2, which are retroviruses primarily infecting CD4+ lymphocytes and macrophages. HIV-1 is the primary causative virus infecting persons in Central Africa, the United States, Europe, and Australia (Copstead-Kirkhorn 237).
Mode of transmission: The mode of transmission for HIV types 1 and 2 is sexual contact with semen, vaginal, and cervical secretions; parenteral transmission via blood, blood products, and contaminated needles; perinatal transmission from an infected mother to her infant antepartum, intrapartum, and postpartum via breast milk (Copstead-Kirkhorn 237).
Life cycle-The life cycle of the RNA virus, HIV, begins with reversal transcription within infected cells to form viral DNA, the enzymes needed include reverse transcriptase, integrase, and protease (Copstead 239). HIV gains access to CD4+ cells by attaching to the CD4 receptor through mediation of protein gp120 and coreceptorchemokines such as CCR5 or CXCR4 (Copestead 239).
Virulence The virulence of HIV depends on the host’s response by T cell-mediated cytotoxicity or by cytokines and does not mean exposure is automatically an infection; for example, if a woman’s plasma viral load may predict the amount of her genital HIV viral shedding, which may influence the exposure to HIV by her sexual partner (COPESTEAD 236). HIV progression in children depends on the timing of the infection, viral load, immune response and the virulence of the virus, but is more rapid than in adults (COPESTEAD 243).
Environmental Factors
Physical properties: In the U.S. HIV is mostly an urban disease, most cases occur in metropolitan areas with 500,000 or more people with the South having the highest prevalence rate (CDC 2015). Sub-Saharan Africa suffers the heaviest burden of HIV worldwide. (CDC 2015).
Biological entities: Scientists reported a type of chimpanzee in Central Africa as the original source of HIV in humans because when humans hunted the chimpanzees for meat and came in contact with the infected blood, the virus was then transmitted to humans (CDC 2015).
Social and economic considerations: Poverty and low education levels put a person more at risk of contracting HIV. Health care workers are on the front lines handling blood and bodily fluids of HIV patients and must use standard precautions with all patients to decrease their risk of infection (Copstead-Kirkhorn 232).
Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up).
The role of the community health nurse is to evaluate nursing care provided to communities. This evaluation includes planning and evaluation; collecting data; analyzing and interpreting the data; reporting the evaluation; and implementing recommendations (Maurer 461-462). When the nurse is evaluating HIV transmission, contact tracing is used to identify all sexual partners of the infected individual. These partners are considered Level I contacts, meaning the most intimate contact, Level II and III are considered less intimate contacts (Maurer 227). In finding cases, the goal is to find every new case and provide immediate treatment to prevent further spreading of the disease (Maurer 227). Because of embarrassment for the HIV patient, the nurse has be to be accepting and caring during the evaluation process in order for the patient to cooperate in helping to locate Level I contacts who may have been infected (Maurer 227).
Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organization(s) contributes to resolving or reducing the impact of disease.
In order to improve health worldwide both intergovernmental and voluntary agencies must work together and focus on global health problems. The World Health Organization (WHO) is the most well known intergovernmental organization composed of approximately 193 countries (Maurer & Smith, 2013 p. 116). The WHO “directs and coordinates international health projects, collaborates with other organizations and agencies in health care programs, and monitors and reports on worldwide disease conditions, much like the Centers for Disease Control and Prevention (CDC) does for the United States” (Maurer & Smith, 2013 p. 117).
An international effort has concentrated on primary prevention of HIV. Examples include: education on what causes HIV and it is spread; advocacy of using protective measures during sexual activity; improvement in the procurement, storage, and administration of blood; and advocacy efforts aimed at high risk individuals because they have multiple sexual partners (Maurer & Smith, 2013 p. 120).
A minimum of three references is required.
Refer to “Communicable Disease Chain” and “Chain of Infection” for assistance completing this assignment.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
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10.0 % Comprehensive Description of a Communicable Disease and the Demographic of Interest
Overview describing the demographic of interest and clinical description of the communicable disease is presented with a thorough, accurate, and clear overview of all of the clinical descriptors.
10.0 % Determinants of Health and Explanation of How Determinants Contribute to Disease Development
Paper comprehensively discusses the determinants of health in relation to the communicable disease, explains their contribution to disease development, and provides evidence to support main points.
25.0 % Epidemiologic Triangle (Host Factors, Agent Factors, and Environmental Factors)
The communicable disease is described thoroughly, accurately, and clearly within an epidemiological model. A visual description of the model and how the components of the model interact is included.
25.0 % Role of the Community Health Nurse
Discussion of the role of the community health nurse is clear, comprehensive, and inclusive of the community nurse’s responsibilities to primary, secondary, and tertiary prevention through tasks such as case finding, reporting, data collection and analysis, and follow up
10.0 % National Agency or Organization That Works to Addresses Communicable Disease
An agency or organization is identified. A clear and accurate description of efforts to address communicable disease is offered.
5.0 % Thesis Development and Purpose