Health Needs Assessment of People Living With HIV in the United Kingdom

HEALTH NEEDS ASSESSMENT FOR PEOPLE LIVING WITH HIV IN THE UK
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Health Needs Assessment
Health assessment of HIV is critical in identifying the health needs of a community or group to formulate strategies to address the needs of the healthcare systems (CDC, 2017). Early testing and diagnosis have been considered helpful in the management of the disease through nursing and management with Antiretroviral. Many factors that contribute to the prevalence of HIV are largely cultural and economic (CDC, 2017). Assessment of any community’s health is critical as it provides baseline data and knows the status of the community health issues. The information is essential for decision-making to enable response and define strategies that can be used to address the issues. At the end of 2016, 19.5 million people in the world were reported to be taking Antiretroviral therapy (ART). The World Health Organization’s recommendation on “treat all” will result in an additional 17.2 million starting the ART bringing the total to 36.7 million (CDC, 2017). This study focuses on the needs assessment of HIV for men and women in the UK. It is reported that in the UK, 1 out of 4 with HIV are not aware of their diagnosis, and nearly half with CD cells of less than 350 cells/microlitre CITATION Mel18 \l 1033 (Melhuish, 2018).
Identify the health needs
To give intervention for the people living with HIV, identification of the need gives the specific information for the response for any particular population. For this particular study, three studies done in the UK have been reviewed to give insight into their needs for different particular groups. The first item focused on the research study that has been done on trans men in the UK due to the increasing rates of HIV and AIDS CITATION Jas18 \l 1033 (Jaspal, 2018). The group involves individuals who are born female but identify as men. Such groups are highly considered vulnerable due to the way society views their inclination. Understanding their sexual health helps in the determination of the health services that can be offered to them. The research is based on a qualitative interview that sampled respondents. The research demonstrated sample population interaction with transgender and non-transgender and showed the level of interaction. The selected research proved 65.2 % of the respondents had got their partners from the internet. This demonstrated the extent of privacy that this category exhibits when looking for partners. The outcome of the research demonstrates the kind of care that the group can be accorded based on their history and sources where they can interact with their clients CITATION Jas18 \l 1033 (Jaspal, 2018)
Research on the elimination of HIV transmission and AIDS and HIV-related death in the UK was also conducted. The main objective was to establish the trend of HIV infections and death in the UK from 2007 -2016 and help in the formulation of public health response CITATION Bro18 \l 1033 (Brown, 2018). The study adopted clinical research for the surveillance. The diagnoses were extracted from the HIV and Aids reporting system. From the research, it is possible to have a clear assessment of the needs of this group since the information retrieved shows the mortality rates. The key information is critical for the clinical management of the disease and able to show the trend scientifically. The research findings showed a decline in transmission due to a decline in the migrants into the UK CITATION Bro18 \l 1033 (Brown, 2018). From this perspective, it can be argued that the needs assessment demonstrated the factors for the increase in infection, which in this case could be associated with early diagnosis and management of the infected persons CITATION Bro18 \l 1033 (Brown, 2018). The study also demonstrated other prevention measures in places like the promotion of the use of condoms and the role of technology in the infection rates.
The third research explored a qualitative study looking into the factors associated with testing for HIV for people above 50 years in the UK CITATION You18 \l 1033 (Youssef, 2018). The study focused on interviews for the age group and analyzed various factors such as HIV campaigns, symptoms, knowledge, risk and risk perception, generation approach to health and health systems, stigma, testing, and testing venue CITATION You18 \l 1033 (Youssef, 2018). The research demonstrates that the health needs of people living with HIV are not limited to a particular group. For instance, the study indicated that there was a rise in diagnoses for people above 50 years and also a rise in new infections. The older generation could also be at risk; hence the need assessment should be holistic to cover all groups and not based on assumptions.
Mapping Theories for HIV
Clinical studies for mapping the interaction for the people living with HIV in the UK proved that failure to keep people in long-life care affects population-level health (Bristowe et al., 2019). Therefore, the adoption of person-centered care could benefit PLWHA and the various stakeholders. The study adopted a cross-national multi-centre study whereby semi-structured qualitative interviews were conducted with 57 participants (PLWHA, professionals, and commissioners). In the study, People living with HIV were (n= 28), professionals (n=21) and commissioners (n=8). The study considered six domains that entail social, psychological, welfare as well as the need for information (Bristowe et al., 2019).
Table 1: Mapping studies
Title

Methodology

Finding

Related health need theories

Identify the type of health needs

Mapping interaction between multiple factors that influence long time engagement for HIV (Youssef, 2018)
https://doi.org/10.1371/journal.pone.0193641

Stratified sampling

The act of caring and serving those with HIV care is a social act, not individual

Maslow’s theory on safety needs and self-actualization needs

Focuses on emotional support

HIV and trans and non-binary people in the UK (Jaspal et al., 2018) https://mc.manuscriptcentral.com/sti

Meta-analysis of data

Nature of care applicable to the group based on background and potential interaction sources with clients

Doyal and Gough theory on behaviours of the group towards care

Comparative need

Mapping the ethics landscape (Dubé, 2017) https://doi.org/10.1371/journal.pmed.1002470

Clinical research

Ethical and implementation challenges related to treatment and management of HIV

Intervention mapping

Social-cultural, regulatory and policy implementation

Effects of Mobile Health prompts on self-monitoring.
doi: 10.2196/12956

Secondary quantitative methodology

The application of mobile methods for tracking physical activity

Doyal and Gough theory. Explains behavioural intentions successfully towards acceptance of mobile phones to track health needs

Comparative need

Towards person‐centred care for people living with HIV: what core outcomes matter, and how might we assess them?
(Bristowe et al., 2019).
DOI: 10.1111/hiv.12758

A cross‐national multi‐centre qualitative study

Intervention mapping successful in planning and implementation of interventions

Intervention mapping

Comparative need

Discussion of health needs theories
Maslow’s Hierarchy theory provides an elaborate definition of human physiological needs and safety (Hale, Ricotta, Freed, Smith, & Huang, 2019). The theory provides a critical guideline that is beneficial for providing care to Persons Living with HIV/AIDS. As provided by Maslow, the hierarchy of needs helps in the understanding of the underlying motivation capable of providing individual satisfaction on various needs (Oved, 2017). The needs are classified as basic, psychological, and self-fulfillment needs. Within the basic needs, love needs are considered to proceed with the safety needs (Oved, 2017). The people living with HIV require more love and should not be discriminated against in society. This gives a sense of belonging and psychological comfort when they are shown love by their loved ones.
Poverty and economic status for some of the victims deprive them of basic needs like food to improve their nutrition CITATION Reb18 \l 1033 (Rebeiro, 2018). Access to better nutrition has also proven to improve the health of patients CITATION Reb18 \l 1033 (Rebeiro, 2018). Health care needs for HIV involve access to healthcare services where they are monitored and receive services such as life-prolonging medicine and nursing services from health professionals ( CITATION Reb18 \l 1033 (Rebeiro, 2018). The socio-economic status theory of health behavior has been proven in epidemiological studies that people with lower socioeconomic status suffer from higher mortality and overall health than those with higher economic status (Scheid, 2017). People with lower Socioeconomic status have lower access to physical activities that improve their well-being, better medical facilities, and better access to diagnosis (Scheid, 2017). The group with lower socioeconomic status has been considered to engage in activities that easily expose them to contracting HIV (Scheid, 2017).
Seedhouse’s theory argues that the achievement of effective health promotion requires maximum cooperation between the various principles of openness that underpins the various political philosophies that define liberal operations, social justice, egalitarianism, and utilitarianism CITATION Cla18 \l 1033 (Clay, 2018). The theory mainly focuses on the services from health promoters that should always provide patients with the hope of improved health conditions at any given time. It is always mandatory that health practitioners provide adequate assistance and services that could provide lasting solutions to Persons Living with HIV/AIDS, especially on the basis of their current health condition CITATION Cla18 \l 1033 (Clay, 2018). Seedhouse further argues that various health intervention measures should have the capability of removing any form of hindrances towards attaining higher human potential (von Heimburg et al., 2020).
The argument by Doyal and Goug concerns the principle of autonomy, which is based on the premise that the provision of essentialities should consider alternative solutions to individuals without subjecting them to any form of coercion CITATION Jon18 \l 1033 (Jones, 2018). It provides differentiation of the health needs from the basic needs. The concept of providing various intermediate needs is always essential, for instance, the Persons Living with HIV/AIDS appear to be more considerate of healthcare costs, including the aspect of accessibility to healthcare services owing to their economic security status CITATION Jon18 \l 1033 (Jones, 2018). The rising costs of healthcare services in recent years have provided considerable challenges to Persons Living with HIV/AIDS due to the high level of expenditure on healthcare CITATION Cla18 \l 1033 (Clay, 2018). This is highly attributable to opportunistic infections that closely relate to HIV. Due to the high disease burden, healthcare is currently considered one of the largest sectors in most countries in Africa. The allocation of resources for healthcare is also inadequate to meet the ever-increasing demand. Africa relies heavily on donor funding for HIV and malaria treatment from the West. There exists significant variation in healthcare utilisation owing to the various constraints as provided by the federal government concerning universal healthcare (Pennel et al., 2016).
Prioritizing health needs
The focus of the Bradshaw theory is on normative need, Comparative need, Expressed need as well as Felt Need. First, Normative need entails the nature of comments provided by healthcare practitioners regarding the recommended standard alongside the services deemed adequate for Persons living with Hiv/Aids CITATION Joh18 \l 1033 (Johnson, 2018). Secondly, Comparative need objectively defines the various forms of needs and the availability of recommended health services and standards that could satisfy the need CITATION Joh18 \l 1033 (Johnson, 2018). Thirdly, expressed need provides an adequate definition of the various services used by individuals, and ultimately felt the need to provide individual definitions of various personal wants (Aziz, Kessler & Huhn, 2013).
Comprehensively, the aspect of prioritization of healthcare needs requires the provision of a methodology capable of availing adequate monitoring abilities, including promotion of equity in the process of providing healthcare services (Shaw et al., 2019). Such a comprehensive plan could easily help address existing healthcare inequalities that may arise while dealing with persons living with HIV/AIDS (Shaw et al., 2019). However, the aforementioned assessment comprises aspects that help satisfy an individual interest or request towards development funding in the healthcare sector (Pennel et al., 2016). Such assessments also reflect the provisions that deal with existing health problems and the occurrence of critical problems, including documentation of findings regarding the current disease burden (Pennel et al., 2016).
Mental health care presents one of the most prevalent unmet needs existing amongst Persons Living with HIV/AIDS CITATION Ras18 \l 1033 (Rasoolinajad, 2018). A good example is depression that, in most cases, remains not attended to medically owing to a lack of mental health experts. Further, substance abuse treatment service needs are also prevalent amongst the HIV population CITATION Ras18 \l 1033 (Rasoolinajad, 2018). Cases of substance abuse have the potential of increasing risk on HIV transmission, especially through injection drugs, taking sexual risks while under the influence of drugs CITATION Dun18 \l 1033 (Duncan, 2018). The activity also acts as a major obstacle towards adherence to treatment for those with HIV (Campbell, Tross, & Calsyn, 2013). The Oral conditions that relate to HIV disease are also ignored in most instances while seeking medication (Campbell, Tross, & Calsyn, 2013). The extent to which Persons Living with HIV/AIDS utilises oral condition services remains very low, especially in rural settings, despite service availability. Moreover, Persons Living with HIV/AIDS always prioritises seeking medical care for other physical issues ahead of oral health due to fear of associated cost (Campbell, Tross, & Calsyn, 2013).
Considerations
The study considers ways of influencing behaviour change at the community level that target the behavioural intention of using appropriate intervention measures for people living with HIV in the community. Therefore, effective needs assessment requires that the available key information at hand in consideration of the underlying assumptions rather than evidence should be scrutinized during need assessment. There is always a need for the establishment of separate processes that utilises research data within the intended area of concern and, where possible, work through the utilisation of expert opinions concerning the established public health protocols. Science and art should be fairly balanc...