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Health educational strategies for people living with HIV: scoping review

Abstract

Objective

To map the scientific production on educational strategies and the content covered in the education of people living with HIV.

Methods

This is a scoping review in which the selection of articles was carried out in April 2021 and updated in October 2022 in ten data sources; the review followed the assumptions established by the Joanna Briggs Institute and the checklist of Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The results were descriptively analyzed and summarized in a chart.

Results

A total of 17 studies were selected, predominantly published in 2017; The USA and Brazil were the countries with the largest number of productions. Most studies sought to evaluate the impact and effectiveness of strategies and develop or validate health education instruments and prevention activities. Concerning the content covered by the strategies, five categories were formed: initial guidance on HIV/AIDS, general care, healthy living, sexual health, and emotional support. The educational strategies that stood out concerning greater patient adherence to treatment are related to the development of systems, programs, and multimedia. The booklets promoted empowerment and autonomy for people living with HIV.

Conclusion

The main educational strategies were mapped, with emphasis on booklets, printed material, multimedia resources, systems, forms, and workshops, covering initial guidance on HIV/AIDS, pharmacological treatment, general care, healthy living, sexual health, and social and emotional support. Open Science Framework (OSF): https://osf.io/754uk/?view_only=6491865a3d12424d81af2c4099c112c3

HIV infections; Acquired immunodeficiency syndrome; Health education; Teaching; Educational technology

Resumo

Objetivo

Mapear a produção científica sobre as estratégias educativas e os conteúdos abordados na educação de pessoas vivendo com HIV.

Métodos

Esta é uma revisão de escopo em que a seleção dos artigos foi realizada em abril de 2021 e atualizada em outubro de 2022 em dez fontes de dados; a revisão seguiu os pressupostos estabelecidos pelo Joanna Briggs Institute e o checklist dos Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Os resultados foram analisados descritivamente e sintetizados em um quadro.

Resultados

Foram selecionados 17 estudos com publicação predominante em 2017; Estados Unidos da América e Brasil foram os países com a maior quantidade de produções. A maioria dos estudos buscou avaliar o impacto e a eficácia das estratégias e desenvolver ou validar instrumentos de educação em saúde e atividades de prevenção. Em relação ao conteúdo abordado pelas estratégias, foram formadas cinco categorias: orientação inicial sobre HIV/AIDS, cuidados gerais, vida saudável, saúde sexual e suporte emocional. As estratégias educativas que se destacaram em relação à maior adesão dos pacientes ao tratamento estão relacionadas com o desenvolvimento de sistemas, programas e multimídia. As cartilhas promoveram empoderamento e autonomia de pessoas vivendo com HIV.

Conclusão

Foram mapeadas as principais estratégias educativas, com destaque para cartilhas, material impresso, recursos multimídia, sistemas, formulários e oficinas/workshops, abordando orientação inicial sobre HIV/AIDS, tratamento farmacológico, cuidados gerais, vida saudável, saúde sexual e suportes social e emocional.

Infecções por HIV; Síndrome da imunodeficiência adquirida; Educação em saúde; Ensino; Tecnologia educacional

Resumen

Objetivo

Mapear la producción científica sobre las estrategias educativas y los contenidos abordados en la educación de personas que viven con el VIH.

Métodos

Esta es una revisión de alcance, cuya selección de artículos se realizó en abril de 2021 y se actualizó en octubre de 2022 en diez fuentes de datos. La revisión siguió las premisas establecidas por el Joanna Briggs Institute y la checklist de los Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Los resultados fueron analizados descriptivamente y sintetizados en un cuadro.

Resultados

Se seleccionaron 17 estudios con publicación predominante en 2017. Estados Unidos de América y Brasil fueron los países con mayor cantidad de producciones. La mayoría de los estudios buscó evaluar el impacto y la eficacia de las estrategias y elaborar o validar instrumentos de educación para la salud y actividades de prevención. Con relación al contenido abordado por las estrategias, se formaron cinco categorías: instrucciones iniciales sobre VIH/SIDA, cuidados generales, vida saludable, salud sexual y apoyo emocional. Las estrategias educativas que se destacaron con relación a una mayor adhesión de los pacientes al tratamiento están relacionadas con el desarrollo de sistemas, programas y multimedia. Las cartillas promovieron empoderamiento y autonomía de personas que viven con el VIH.

Conclusión

Se mapearon las principales estrategias educativas, con énfasis en cartillas, material impreso, recursos multimedia, sistemas, formularios y talleres/workshops, que abordaron instrucciones iniciales sobre VIH/SIDA, tratamiento farmacológico, cuidados generales, vida saludable, salud sexual y apoyo social y emocional. Open Science Framework (OSF): https://osf.io/754uk/?view_only=6491865a3d12424d81af2c4099c112c3

Infecciones por VIH; Síndrome de inmunodeficiencia adquirida; Educación en salud; Enseñanza; Tecnología educacional

Introduction

The number of people infected with the Human Immunodeficiency Virus (HIV) in the world has been estimated at 38.4 million. Around 1.5 million people were infected with HIV in 2021. In Brazil, about 435 thousand cases of HIV infection were reported from 2007 to June 2022.(11. Brasil. Programa Conjunto das Nações Unidas sobre HIV/AIDS (Brasil). Estatística. UNAIDS; 2022 [citado 2023 Mar 20]. Disponível em: https://unaids.org.br/estatisticas/
https://unaids.org.br/estatisticas/...
)

From this perspective, these individuals are at risk of developing neoplasia and opportunistic infections associated with Acquired Immune Deficiency Syndrome (AIDS). However, the improvement in the effectiveness of antiretroviral therapy (ART) and multidisciplinary monitoring contributed to improvements in the quality of life of the affected population, reducing the number of deaths due to acute complications.(22. Santos BR, Maciel DO, Silva CA, Carneiro MN, Gursen JG, Brito LR, et al. Jogo educativo como estratégia de educação em saúde para pessoas vivendo com HIV/AIDS. IJHE. 2019;4(1-2):49–54.)

We highlight that a delay occurred in the diagnosis and treatment of patients due to the COVID-19 pandemic, which directly impacted services aimed at prevention and harm reduction.(33. Brasil. Ministério da Saúde. Boletim Epidemiológico. HIV/AIDS. Brasília (DF): Ministério da Saúde, 2022[citado 2023 Mar 20]. Disponível em: https://www.gov.br/aids/pt-br/centrais-de-conteudo/boletins-epidemiologicos/2022/hiv-aids/boletim_hiv_aids_-2022_internet_31-01-23.pdf/view
https://www.gov.br/aids/pt-br/centrais-d...
) The difficulty in accessing centers and units to carry out screening tests for HIV diagnosis during the Pandemic was observed in countries such as Brazil, Japan, China, and Belgium.(44. Ejima K, Koizumi Y, Yamamoto N, Rosenberg M, Ludema C, Bento AI, et al. HIV Testing by Public Health Centers and Municipalities and New HIV Cases During the COVID-19 Pandemic in Japan. J Acquir Immune Defic Syndr. 2021;87(2):e182–7.

5. Jiang H, Xie Y, Xiong Y, Zhou Y, Lin K, Yan Y, et al. HIV self-testing partially filled the HIV testing gap among men who have sex with men in China during the COVID-19 pandemic: results from an online survey. J Int AIDS Soc. 2021;24(5):e25737.
-66. Darcis G, Vaira D, Moutschen M. Impact of coronavirus pandemic and containment measures on HIV diagnosis. Epidemiol Infect. 2020;148(1):e185.)

Thus, the impacts caused by COVID-19 contributed to accentuating inequalities related to the fight against HIV. We also emphasize that a social stigma associated with HIV and related to beliefs and negative thoughts towards infected people is also widespread, causing discrimination and social isolation.(11. Brasil. Programa Conjunto das Nações Unidas sobre HIV/AIDS (Brasil). Estatística. UNAIDS; 2022 [citado 2023 Mar 20]. Disponível em: https://unaids.org.br/estatisticas/
https://unaids.org.br/estatisticas/...
,77. Dunn Navarra AM, Viorst Gwadz M, Bakken S, Whittemore R, Cleland CM, D’Eramo Melkus G. Adherence connection for counseling, education, and support: research protocol for a proof-of-concept study. JMIR Res Protoc. 2019;8(3):e12543.)

Assistance to people living with HIV/AIDS (PLWHA) must be seen by health professionals from a perspective of comprehensive care, in which strengthening their autonomy to practice self-care is possible. Health services need to be aware of new resources and skills that can be used for the benefit of patients, especially those associated with health education, which is essential to promote the quality of life of people living with HIV.(88. Ferreira SL, Sousa IV, Fernandes MV, Esteves AV, Rocha EP. A percepção de cuidadoras sobre os cuidados com a criança soropositiva ao HIV. Enferm Bras. 2019;18(3):365–72.)

Thus, health education is a strategy of adherence to pharmacological treatment, as it uses clarification approaches about the health-disease process (such as transmission, prevention, and models of treatment); it aims at the evolution of patients in individual practices and behaviors, providing autonomy and quality of life, and collaborating with humanized care, thus reducing the chances of non-adherence to treatment.(22. Santos BR, Maciel DO, Silva CA, Carneiro MN, Gursen JG, Brito LR, et al. Jogo educativo como estratégia de educação em saúde para pessoas vivendo com HIV/AIDS. IJHE. 2019;4(1-2):49–54.)

From this perspective, the use of educational strategies, such as Health Educational Technologies (TES/HET), can contribute to the teaching-learning process, strengthening health education actions. Thus, they can be presented in printed, dialogued, or audiovisual forms; the latter form is crucial in the teaching-learning process as it can promote significant results in the acquisition of knowledge if appropriate materials, principles, and appropriate forms of communication are involved.(99. Teixeira E, Palmeira IP, Rodrigues IL, Brasil GB, Carvalho DS, Machado TD. Participative development of educational technology in the HIV/AIDS context. REME. 2019;23:e-1236.)

When defining nurses as qualified for education based on TES, the following didactic elements are highlighted: use of objective and clear language, insertion of images and punctuation of the most common doubts that should make up the educational strategies.(88. Ferreira SL, Sousa IV, Fernandes MV, Esteves AV, Rocha EP. A percepção de cuidadoras sobre os cuidados com a criança soropositiva ao HIV. Enferm Bras. 2019;18(3):365–72.,99. Teixeira E, Palmeira IP, Rodrigues IL, Brasil GB, Carvalho DS, Machado TD. Participative development of educational technology in the HIV/AIDS context. REME. 2019;23:e-1236.) Furthermore, TES must provide comprehensive care, promoting self-care, autonomy, and socialization of knowledge. These characteristics are not considered when the resource is produced without due preparation.(1010. Thomas LS, Fontana RT. Use of Information and Communication Technologies as an educational media in health: integrative review. Res Soc Dev. 2020;9(10):e9869109321.)

Thus, it is important that HIV/AIDS be the subject of more studies by the scientific community as it is an important factor of morbidity and mortality and social disparity. This study was then justified by the need to seek educational strategies that contribute to teaching people living with HIV and can be used by health professionals.

Therefore, the objective of the present study was to map the scientific production on educational strategies and the content approached in the education of people living with HIV.

Methods

This was a scoping review to map the main scientific concepts and evidence existing in the literature on a given area of knowledge, identifying their gaps. The study was developed according to the guidelines of the Joanna Briggs Institute Review Manual,(1111. Peters MD, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H, et al. Scoping Reviews (2020 version). In: Aromataris E, Munn , editors. Joanna Briggs Institute Reviewer’s Manual, JBI 2020 [cited 2021 Jan 20]. Available from: https://reviewersmanual.joannabriggs.org/
https://reviewersmanual.joannabriggs.org...
)following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.(1212. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and Explanation. Ann Intern Med. 2018;169(7):467–73.)

We highlight that the PRISMA-ScR checklist consists of seven items (title, summary, objectives, research, selection of sources of evidence, synthesis of results, and expected results). Therefore, to prepare a scoping review the following steps were followed: (1) definition of the research question and objectives; (2) definition of eligibility criteria; (3) description of the planned approach, search and selection of studies, data extraction, and presentation of evidence; (4) search for evidence; (5) selection of evidence; (6) extraction of evidence; (7) analysis of extracted evidence; (8) presentation of results; and (9) summary of evidence concerning the objective of review.(1111. Peters MD, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H, et al. Scoping Reviews (2020 version). In: Aromataris E, Munn , editors. Joanna Briggs Institute Reviewer’s Manual, JBI 2020 [cited 2021 Jan 20]. Available from: https://reviewersmanual.joannabriggs.org/
https://reviewersmanual.joannabriggs.org...
-1212. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and Explanation. Ann Intern Med. 2018;169(7):467–73.)

To preserve the legitimacy of the review and identify duplicity of studies a preliminary search was carried out on the following international registration platforms: International Prospective Register of Systematic Reviews (PROSPERO), Open Science Framework (OSF), The Cochrane Library, JBI Clinical Online Network of Evidence for Care and Therapeutics (COnNECT+), and Database of Abstracts of Reviews of Effects (DARE). The results found showed the scarcity of this topic in the literature, indicating that carrying out this study would be important. Furthermore, the study protocol was registered on the OSF platform: <https://osf.io/754uk/?view_only=6491865a3d12424d81af2c4099c112c3>.

The PCC (Population, Concept, and Context) mnemonic was used to formulate the research question.(1111. Peters MD, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H, et al. Scoping Reviews (2020 version). In: Aromataris E, Munn , editors. Joanna Briggs Institute Reviewer’s Manual, JBI 2020 [cited 2021 Jan 20]. Available from: https://reviewersmanual.joannabriggs.org/
https://reviewersmanual.joannabriggs.org...
) Thus, people living with HIV were designated as the study population, health educational strategy as the concept, and health services as the context. The following question was then created: “What health educational strategies and content are addressed in Health Services for teaching people living with HIV?”

The data searches were carried out in April 2021 and updated in October 2022 by consulting the collection of the following data sources: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Science Direct, Literatura Latino-Americana em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), Scopus, Web of Science, Virtual Library of Nursing (BDENF), and Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed). For gray literature (dissertations and theses), the Digital Library of Theses and Dissertations (BDTD) and Google Scholar were also consulted.

The descriptors used were based on the Descriptors in Health Sciences (DeCS) and Medical Subject Headings (MeSH): HIV Infections, Acquired Immunodeficiency Syndrome, Health Education, Educational technology, Teaching, and Health Services. The Boolean operators “AND” and “OR” were used in the crossing, following the particularities of each source. Access to the data sources mentioned above was made via the Periodical Portal of the Coordination for the Improvement of Higher Education Personnel (CAPES), using remote access to the content of the Federated Academic Community (CAFe), a paid tool from the Federal University of Rio Grande do Norte (UFRN).

The following search strategies were configured in their respective databases: ((“HIV Infections” OR AIDS OR “Acquired Immunodeficiency Syndrome”) AND (“Health Education” OR “Educational technology” OR Teaching)) AND (“Health Services”) was used in PubMed; Science Direct and SciELO: (“HIV Infections” OR AIDS OR “Acquired Immunodeficiency Syndrome”) AND (“Health Education” OR “Educational technology” OR Teaching) AND “Health Services” was used in CINAHL; “HIV infections” OR AIDS OR “Acquired Immunodeficiency Syndrome” [Words] AND “Health Education” OR “Educational technology” OR Teaching [Words] AND “Health Services” [Words] was used in the LILACS database; TITLE-ABS-KEY (“HIV Infections” OR aids OR “Acquired Immunodeficiency Syndrome”) AND TITLE-ABS-KEY (“Health Education” OR “Educational technology” OR teaching) AND TITLE-ABS-KEY (“Health Services”) was used in SCOPUS. ((ALL=(“HIV Infections” OR AIDS OR “Acquired Immunodeficiency Syndrome”)) AND ALL=(“Health Education” OR “Educational technology” OR Teaching)) AND ALL=(“Health Services”) was used on the Web of Science; (“HIV Infections” OR AIDS OR “Acquired Immunodeficiency Syndrome”) AND (“Health Education” OR “Educational Technology” OR Teaching) AND (“Health Services”) was used in BDENF; (All fields: “HIV Infections” OR AIDS OR “Acquired immunodeficiency syndrome” AND All fields: “Health Education” OR “Educational technology” OR Teaching AND All fields: “Health Services”) was used in the Digital Library of Theses and Dissertations (BDTD); and (“HIV Infections”) AND (“Educational technology”) AND (“Health Services”) was used in Google Scholar.

Publications fully and freely available electronically, without restrictions on language, time frame, and objective of the study were included. Summaries, letters to the editor, opinion articles, and studies that deviate from the proposed theme were excluded.

The inclusion of studies was carried out rigorously, first consulting titles and abstracts and then reading the articles in full. The selection was made simultaneously by two independent evaluators on the same day, on different electronic devices. Disagreements were resolved with the help of a third reviewer, who then decided whether or not the questioned article would be incorporated into the review.

After selecting the final sample, the data obtained was organized and summarized in a chart with the following variables: year of publication, country, content of educational strategies, and content categories. The results were analyzed using descriptive statistics. In addition, the PAGER methodology was used. It was developed by researchers to offer a more detailed approach to findings and improve the quality of reporting evidenced in scoping reviews, extending the rigor of results through consistent analysis through the following elements: Standards, Advances, Gaps, Evidence of Practice, and Research Recommendations.(1313. Bradbury-Jones C, Aveyard H, Herber OR, Isham L, Taylor J, O’Malley L. Scoping reviews: the PAGER framework for improving the quality of reporting. Int J Soc Res Methodol. 2021;25(4):457-70.)

The present study was not submitted to the Ethics and Research Committee (CEP/ERC) as the data included were in the public domain.

Results

A total of 9,266 studies were obtained from the searches in data sources; after applying the inclusion and exclusion criteria, 46 studies were evaluated and 17 were selected to compose the final sample; two of them were from grey literature (Figure 1).

Figure 1
Flowchart of study selection

Regarding the year of publication, studies in the period 1994-2022 were identified; more scientific articles were published in 2017 (4; 23.5%), 2018 (3; 17.6%), 2019 and 2020 (2; 11.7%). In other years, only one was published (1; 5.8%). As for publishing countries, the USA (USA) and Brazil published the largest number of studies (7; 41.1%), followed by the United Kingdom (2; 11.7%), with the development of educational technologies in this area. In the total studies, the objectives were the following: evaluate the impact, effectiveness, and effect of a given educational strategy in the care retention process and reducing stigma and learning of participants (7; 41.1%), developing and validating a health education instrument (5; 29.4%), developing a new tool based on educational needs encountered by this population (3; 17.6%), and developing health prevention and promotion activities (2; 11.7%). Regarding the results, information about HIV/AIDS was generally content in educational strategies, adequate drug treatment, measurement of viral load, knowledge about prevention and prophylaxis, sexual health and emotional support for patients, sexual partners and family members, development of self-care, autonomy, and stigma reduction, as well as monitoring, medical coverage and referral, and promotion of HIV testing. The studies showed relevant elements in the composition of educational resources, which were distributed into five categories: initial guidance, general care, healthy living, sexual health, and emotional support (Chart 1). The educational strategies identified in the articles were the following: booklets and printed educational materials (8; 47.0%), systems on care, support, and communication (3; 17.6%), multimedia (4; 23.5%), forms and interviews (2; 11.7%), and instant messaging and workshops (1; 5.8%). These results are presented in chart 1.

Chart 1
Categorization of studies on identification, country, year, educational strategies, content of strategies, and content categories

The PAGER methodology was used to enhance the rigor, increase the quality of this review, and provide a consistent approach to the analysis and reporting of the selected studies. The PAGER structure is shown in chart 2.

Chart 2
PAGER structure based on the studies analyzed

Discussion

From the analysis of the selected studies, it is possible to verify that the scope presents important information about the contents covered by the health educational strategies aimed at people living with HIV. Elements relevant to this research were thus identified and categorized in these studies: initial guidance(1414. Gustafson DH, Hawkins RP, Boberg EW, Bricker E, Pingree S, Chan CL. The use and impact of a computer-based support system for people living with AIDS and HIV infection. Proc Annu Symp Comput Appl Med Care. 1994:604-8.,88. Ferreira SL, Sousa IV, Fernandes MV, Esteves AV, Rocha EP. A percepção de cuidadoras sobre os cuidados com a criança soropositiva ao HIV. Enferm Bras. 2019;18(3):365–72.,2020. Leadbal OD, Medeiros LB, Lins KS, Chaves RB, Monroe AA, Nogueira JA. Rev Enferm UERJ. 2017;25:e9524.,2222. Lima AC, Bezerra KC, Sousa DM, Rocha JF, Oriá MO. Development and validation of a booklet for prevention of vertical HIV transmission. Acta Paul Enferm. 2017;30(2):181–9.)and general care,(22. Santos BR, Maciel DO, Silva CA, Carneiro MN, Gursen JG, Brito LR, et al. Jogo educativo como estratégia de educação em saúde para pessoas vivendo com HIV/AIDS. IJHE. 2019;4(1-2):49–54.,1515. Woods ER, Samples CL, Melchiono MW, Keenan PM, Fox DJ, Chase LH, et al. Boston HAPPENS Program a model of health care for hiv-positive, homeless, and at-risk youth. J Adolesc Health. 1998;23(2 2S):37–48.

16. Kalichman SC, Hudd K, Diberto G. Operational fidelity to an evidence-based HIV prevention intervention for people living with HIV/AIDS. J Prim Prev. 2010;31(4):235–45.
-1717. Rivera AV, DeCuir J, Crawford ND, Amesty S, Harripersaud K, Lewis CF. Factors associated with HIV stigma and the impact of a nonrandomized multi-component video aimed at reducing HIV stigma among a high-risk population in New York City. AIDS Care. 2015;27(6):772–6.,1818. Tanner AE, Mann L, Song E, Alonzo J, Schafer K, Arellano E, et al. weCARE: A social media-based intervention designed to increase hiv care linkage, retention, and health outcomes for racially and ethnically diverse young msm. AIDS Educ Prev. 2016;28(3):216–30.

19. Killingo GM, Taro TB, Mosime WN. Community-driven demand creation for the use of routine viral load testing: a model to scale up routine viral load testing. J Int AIDS Soc. 2017;20(S7):1-5.

20. Leadbal OD, Medeiros LB, Lins KS, Chaves RB, Monroe AA, Nogueira JA. Rev Enferm UERJ. 2017;25:e9524.

21. Bayona E, Menacho L, Segura ER, Mburu G, Roman F, Tristan C, et al. The experiences of newly diagnosed men who have sex with men entering the hiv care cascade in Lima, Peru, 2015-2016: A qualitative analysis of counselor-participant text message exchanges. Cyberpsychol Behav Soc Netw. 2017;20(6):389–96.

22. Lima AC, Bezerra KC, Sousa DM, Rocha JF, Oriá MO. Development and validation of a booklet for prevention of vertical HIV transmission. Acta Paul Enferm. 2017;30(2):181–9.

23. Brasil GB, Rodrigues IL, Nogueira LM, Palmeira IP. Educational technology for people living with HIV: validation study. Rev Bras Enferm. 2018;71 Suppl 4:1657–62.

24. Atanga PN, Ndetan HT, Fon PN, Meriki HD, Muffih TP, Achidi EA, et al. Using a composite adherence tool to assess ART response and risk factors of poor adherence in pregnant and breastfeeding HIV-positive Cameroonian women at 6 and 12 months after initiating option B. BMC Pregnancy Childbirth. 2018;18(1):418.

25. Neumann MS, Plant A, Margolis AD, Borkowf CB, Malotte CK, Rietmeijer CA, et al. Effects of a brief video intervention on treatment initiation and adherence among patients attending human immunodeficiency virus treatment clinics. PLoS One. 2018;13(10):e0204599.

26. Jesus GJ, Caliari JS, Oliveira LB, Queiroz AA, Figueiredo RM, Reis RK. Construction and validation of educational material for the health promotion of individuals with HIV. Rev Lat Am Enfermagem. 2020;28(3322):e3322.
-2727. Maloney KM, Bratcher A, Wilkerson R, Sullivan PS. Electronic and other new media technology interventions for HIV care and prevention: a systematic review. J Int AIDS Soc. 2020;23(1):e25439.)sexual health,(1616. Kalichman SC, Hudd K, Diberto G. Operational fidelity to an evidence-based HIV prevention intervention for people living with HIV/AIDS. J Prim Prev. 2010;31(4):235–45.,1818. Tanner AE, Mann L, Song E, Alonzo J, Schafer K, Arellano E, et al. weCARE: A social media-based intervention designed to increase hiv care linkage, retention, and health outcomes for racially and ethnically diverse young msm. AIDS Educ Prev. 2016;28(3):216–30.,2020. Leadbal OD, Medeiros LB, Lins KS, Chaves RB, Monroe AA, Nogueira JA. Rev Enferm UERJ. 2017;25:e9524.,2828. Frazão LR, Gusmão TL, Guedes TG. Construção e validação de cartilha educacional sobre saúde sexual e reprodutiva para casais sorodiscordantes. Cogitare Enferm. 2022;27 e79155:1–13.)emotional support(1515. Woods ER, Samples CL, Melchiono MW, Keenan PM, Fox DJ, Chase LH, et al. Boston HAPPENS Program a model of health care for hiv-positive, homeless, and at-risk youth. J Adolesc Health. 1998;23(2 2S):37–48.,1717. Rivera AV, DeCuir J, Crawford ND, Amesty S, Harripersaud K, Lewis CF. Factors associated with HIV stigma and the impact of a nonrandomized multi-component video aimed at reducing HIV stigma among a high-risk population in New York City. AIDS Care. 2015;27(6):772–6.,2121. Bayona E, Menacho L, Segura ER, Mburu G, Roman F, Tristan C, et al. The experiences of newly diagnosed men who have sex with men entering the hiv care cascade in Lima, Peru, 2015-2016: A qualitative analysis of counselor-participant text message exchanges. Cyberpsychol Behav Soc Netw. 2017;20(6):389–96.,2626. Jesus GJ, Caliari JS, Oliveira LB, Queiroz AA, Figueiredo RM, Reis RK. Construction and validation of educational material for the health promotion of individuals with HIV. Rev Lat Am Enfermagem. 2020;28(3322):e3322.)and healthy living.(22. Santos BR, Maciel DO, Silva CA, Carneiro MN, Gursen JG, Brito LR, et al. Jogo educativo como estratégia de educação em saúde para pessoas vivendo com HIV/AIDS. IJHE. 2019;4(1-2):49–54.,99. Teixeira E, Palmeira IP, Rodrigues IL, Brasil GB, Carvalho DS, Machado TD. Participative development of educational technology in the HIV/AIDS context. REME. 2019;23:e-1236.,2020. Leadbal OD, Medeiros LB, Lins KS, Chaves RB, Monroe AA, Nogueira JA. Rev Enferm UERJ. 2017;25:e9524.,2323. Brasil GB, Rodrigues IL, Nogueira LM, Palmeira IP. Educational technology for people living with HIV: validation study. Rev Bras Enferm. 2018;71 Suppl 4:1657–62.,2626. Jesus GJ, Caliari JS, Oliveira LB, Queiroz AA, Figueiredo RM, Reis RK. Construction and validation of educational material for the health promotion of individuals with HIV. Rev Lat Am Enfermagem. 2020;28(3322):e3322.)

As for educational strategies, the use of booklets and teaching materials can be highlighted as one of the most used instruments, being evidenced as an excellent resource for PLWHA. The process of validating the booklets with experts and the population was an essential factor that contributed to adapting the instruments.(99. Teixeira E, Palmeira IP, Rodrigues IL, Brasil GB, Carvalho DS, Machado TD. Participative development of educational technology in the HIV/AIDS context. REME. 2019;23:e-1236.,2222. Lima AC, Bezerra KC, Sousa DM, Rocha JF, Oriá MO. Development and validation of a booklet for prevention of vertical HIV transmission. Acta Paul Enferm. 2017;30(2):181–9.-2323. Brasil GB, Rodrigues IL, Nogueira LM, Palmeira IP. Educational technology for people living with HIV: validation study. Rev Bras Enferm. 2018;71 Suppl 4:1657–62.,2727. Maloney KM, Bratcher A, Wilkerson R, Sullivan PS. Electronic and other new media technology interventions for HIV care and prevention: a systematic review. J Int AIDS Soc. 2020;23(1):e25439.-2828. Frazão LR, Gusmão TL, Guedes TG. Construção e validação de cartilha educacional sobre saúde sexual e reprodutiva para casais sorodiscordantes. Cogitare Enferm. 2022;27 e79155:1–13.)

In general, positive and relevant outcomes from the use of these strategies were highlighted as the available information and knowledge offered increased coping power.(99. Teixeira E, Palmeira IP, Rodrigues IL, Brasil GB, Carvalho DS, Machado TD. Participative development of educational technology in the HIV/AIDS context. REME. 2019;23:e-1236.) Furthermore, the active participation of the target audience enabled greater autonomy and self-care, which was evidenced by greater adherence to consultations and exams, and better hygiene and nutrition. This allowed us to realize that the content of these instruments is essential to support the construction of a new strategy aimed at people with HIV.(99. Teixeira E, Palmeira IP, Rodrigues IL, Brasil GB, Carvalho DS, Machado TD. Participative development of educational technology in the HIV/AIDS context. REME. 2019;23:e-1236.,2323. Brasil GB, Rodrigues IL, Nogueira LM, Palmeira IP. Educational technology for people living with HIV: validation study. Rev Bras Enferm. 2018;71 Suppl 4:1657–62.,2727. Maloney KM, Bratcher A, Wilkerson R, Sullivan PS. Electronic and other new media technology interventions for HIV care and prevention: a systematic review. J Int AIDS Soc. 2020;23(1):e25439.,2828. Frazão LR, Gusmão TL, Guedes TG. Construção e validação de cartilha educacional sobre saúde sexual e reprodutiva para casais sorodiscordantes. Cogitare Enferm. 2022;27 e79155:1–13.)

Furthermore, educational strategies related to the development of systems and programs are widely used (23.0%), showing benefits for improving life quality and social and emotional support. Advice on diagnostic tests provided by systems and programs was a key point for the observed increase in demand for health services.(1414. Gustafson DH, Hawkins RP, Boberg EW, Bricker E, Pingree S, Chan CL. The use and impact of a computer-based support system for people living with AIDS and HIV infection. Proc Annu Symp Comput Appl Med Care. 1994:604-8.,1515. Woods ER, Samples CL, Melchiono MW, Keenan PM, Fox DJ, Chase LH, et al. Boston HAPPENS Program a model of health care for hiv-positive, homeless, and at-risk youth. J Adolesc Health. 1998;23(2 2S):37–48.)

Thus, the contributions of educational technologies focused on multimedia, such as the use of videos and computer-mediated communication to clarify doubts of people living with HIV/AIDS, are highlighted. The use of educational videos contributed to reducing HIV stigma, strengthening knowledge of PLWHA, and improving adherence to antiretroviral treatment.(1515. Woods ER, Samples CL, Melchiono MW, Keenan PM, Fox DJ, Chase LH, et al. Boston HAPPENS Program a model of health care for hiv-positive, homeless, and at-risk youth. J Adolesc Health. 1998;23(2 2S):37–48.,1616. Kalichman SC, Hudd K, Diberto G. Operational fidelity to an evidence-based HIV prevention intervention for people living with HIV/AIDS. J Prim Prev. 2010;31(4):235–45.,2323. Brasil GB, Rodrigues IL, Nogueira LM, Palmeira IP. Educational technology for people living with HIV: validation study. Rev Bras Enferm. 2018;71 Suppl 4:1657–62.)

From this perspective, the study by Tanner et al. (2016) is highlighted. They developed the weCare social media to improve health care and outcomes for men who have sex with men (MSM) living with HIV. The intervention addresses aspects related to sexual health and HIV, respecting the community’s culture. Through the educational strategy, it was possible to notice an improvement in HIV-related stigma and retention of care, which is essential for developing a new educational strategy.(1818. Tanner AE, Mann L, Song E, Alonzo J, Schafer K, Arellano E, et al. weCARE: A social media-based intervention designed to increase hiv care linkage, retention, and health outcomes for racially and ethnically diverse young msm. AIDS Educ Prev. 2016;28(3):216–30.)

In the results, it is important to highlight that content about healthy eating and self-care is still in its infancy. Physical exercise is a significant factor for HIV patients, as it positively contributes to the immune system by increasing CD4 T-cells in the cardiovascular system, reducing the percentage of fat, and improving the lipid profile, which can interfere with complications due to non-communicable degenerative diseases.(2626. Jesus GJ, Caliari JS, Oliveira LB, Queiroz AA, Figueiredo RM, Reis RK. Construction and validation of educational material for the health promotion of individuals with HIV. Rev Lat Am Enfermagem. 2020;28(3322):e3322.,2929. Santos L, Siqueira M, Siqueira M, Damiani RHC, Damiani RHC, Martelli A et al. Impacto do exercício físico em pessoas com HIV/AIDS. Braz J Technol.];(3)4:130-45.)

Regarding dietary aspects, people with HIV may present progressive malnutrition associated with reduced food intake. This agrees with the observed change in nutrient absorption, increase in energy demands that cause weight loss, and reduction in micronutrients, directly weakening the functioning of the immune system, thus providing a favorable environment for opportunistic infections.(3030. Serrão JR, Peixoto IV, Nascimento CC, Serrão AM, Pamplona MC. Práticas de gestantes soropositivas para HIV sobre o autocuidado: construção de tecnologia educacional em saúde. REAS/EJCH. 2020;38(e1562):1-8.)

Questions about seropositive pregnant women or vertical transmission were also rarely included in the content of educational strategies. These topics are important to be presented by health professionals, as seropositive pregnant women can transmit HIV to their children. Therefore, starting antiretroviral therapy (ART) at the beginning of pregnancy is necessary, interrupting breastfeeding to reduce the possibility of infection.(1717. Rivera AV, DeCuir J, Crawford ND, Amesty S, Harripersaud K, Lewis CF. Factors associated with HIV stigma and the impact of a nonrandomized multi-component video aimed at reducing HIV stigma among a high-risk population in New York City. AIDS Care. 2015;27(6):772–6.,3131. Batista FK, Batista SV, Pereira AR, Silva LC, Rodrigues OS, Freira LR, et al. Perfil nutricional de portadores de HIV/AIDS residentes no Brasil. Rev Eletrôni Acervo Saúde. 2020;13(2)e6190.)

The reinforcement of studies on the importance of using language and methods that are easy to understand for PLHIV is another relevant point as a significant number of people with low education were identified in the results.(22. Santos BR, Maciel DO, Silva CA, Carneiro MN, Gursen JG, Brito LR, et al. Jogo educativo como estratégia de educação em saúde para pessoas vivendo com HIV/AIDS. IJHE. 2019;4(1-2):49–54.,99. Teixeira E, Palmeira IP, Rodrigues IL, Brasil GB, Carvalho DS, Machado TD. Participative development of educational technology in the HIV/AIDS context. REME. 2019;23:e-1236.,1414. Gustafson DH, Hawkins RP, Boberg EW, Bricker E, Pingree S, Chan CL. The use and impact of a computer-based support system for people living with AIDS and HIV infection. Proc Annu Symp Comput Appl Med Care. 1994:604-8.,1515. Woods ER, Samples CL, Melchiono MW, Keenan PM, Fox DJ, Chase LH, et al. Boston HAPPENS Program a model of health care for hiv-positive, homeless, and at-risk youth. J Adolesc Health. 1998;23(2 2S):37–48.,2222. Lima AC, Bezerra KC, Sousa DM, Rocha JF, Oriá MO. Development and validation of a booklet for prevention of vertical HIV transmission. Acta Paul Enferm. 2017;30(2):181–9.

23. Brasil GB, Rodrigues IL, Nogueira LM, Palmeira IP. Educational technology for people living with HIV: validation study. Rev Bras Enferm. 2018;71 Suppl 4:1657–62.

24. Atanga PN, Ndetan HT, Fon PN, Meriki HD, Muffih TP, Achidi EA, et al. Using a composite adherence tool to assess ART response and risk factors of poor adherence in pregnant and breastfeeding HIV-positive Cameroonian women at 6 and 12 months after initiating option B. BMC Pregnancy Childbirth. 2018;18(1):418.
-2525. Neumann MS, Plant A, Margolis AD, Borkowf CB, Malotte CK, Rietmeijer CA, et al. Effects of a brief video intervention on treatment initiation and adherence among patients attending human immunodeficiency virus treatment clinics. PLoS One. 2018;13(10):e0204599.,2727. Maloney KM, Bratcher A, Wilkerson R, Sullivan PS. Electronic and other new media technology interventions for HIV care and prevention: a systematic review. J Int AIDS Soc. 2020;23(1):e25439.)

Furthermore, the importance of maintaining the privacy and anonymity of these patients is highlighted as blaming and HIV shame was more present in people with low levels of education, younger age, and unemployed.(1919. Killingo GM, Taro TB, Mosime WN. Community-driven demand creation for the use of routine viral load testing: a model to scale up routine viral load testing. J Int AIDS Soc. 2017;20(S7):1-5.,2020. Leadbal OD, Medeiros LB, Lins KS, Chaves RB, Monroe AA, Nogueira JA. Rev Enferm UERJ. 2017;25:e9524.)

Maloney et al. (2020) reaffirmed that educational technologies are compatible with the ways of living well for people with HIV and suggested the strategy of using educational materials that help to adhere to drug treatment as it is through specific medication that patients can achieve a reduction in viral load and CD4 T-cell count.(2727. Maloney KM, Bratcher A, Wilkerson R, Sullivan PS. Electronic and other new media technology interventions for HIV care and prevention: a systematic review. J Int AIDS Soc. 2020;23(1):e25439.)

In this sense, videos, systems, programs,(1414. Gustafson DH, Hawkins RP, Boberg EW, Bricker E, Pingree S, Chan CL. The use and impact of a computer-based support system for people living with AIDS and HIV infection. Proc Annu Symp Comput Appl Med Care. 1994:604-8.,1515. Woods ER, Samples CL, Melchiono MW, Keenan PM, Fox DJ, Chase LH, et al. Boston HAPPENS Program a model of health care for hiv-positive, homeless, and at-risk youth. J Adolesc Health. 1998;23(2 2S):37–48.,1717. Rivera AV, DeCuir J, Crawford ND, Amesty S, Harripersaud K, Lewis CF. Factors associated with HIV stigma and the impact of a nonrandomized multi-component video aimed at reducing HIV stigma among a high-risk population in New York City. AIDS Care. 2015;27(6):772–6.,2525. Neumann MS, Plant A, Margolis AD, Borkowf CB, Malotte CK, Rietmeijer CA, et al. Effects of a brief video intervention on treatment initiation and adherence among patients attending human immunodeficiency virus treatment clinics. PLoS One. 2018;13(10):e0204599.)forms(2020. Leadbal OD, Medeiros LB, Lins KS, Chaves RB, Monroe AA, Nogueira JA. Rev Enferm UERJ. 2017;25:e9524.)and interviews(2424. Atanga PN, Ndetan HT, Fon PN, Meriki HD, Muffih TP, Achidi EA, et al. Using a composite adherence tool to assess ART response and risk factors of poor adherence in pregnant and breastfeeding HIV-positive Cameroonian women at 6 and 12 months after initiating option B. BMC Pregnancy Childbirth. 2018;18(1):418.)were the educational strategies highlighted regarding patient adherence to the proposed treatments. The results of the present study can contribute not only to a better understanding of the process of health education using educational resources for people living with HIV but also to sensitize managers in the formulation of public policies for the design and implementation of educational resources in Primary Health Care and hospital care.

The exclusion of articles published in restricted-access journals was the main limitation of this study. Furthermore, the predominance of articles focusing on prevention but not diagnosis and treatment of people with HIV also made the selection of studies difficult.

Conclusion

The main educational strategies and content covered in the education of people living with HIV were mapped. Booklets and printed educational materials, multimedia, systems, forms, and workshops are the educational strategies in use. The content of these strategies includes initial guidance on HIV/AIDS, pharmacological treatment, general care, healthy living, sexual health, and social and emotional support. Focusing on the relevant aspects of the strategies and content addressed in teaching people living with HIV will improve their knowledge and conduct concerning the disease, reducing both stigma and non-adherence to treatment and the number of deaths caused by AIDS.

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Edited by

Associate Editor (Peer review process): Paula Hino (https://orcid.org/0000-0002-1408-196X) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil

Publication Dates

  • Publication in this collection
    04 Mar 2024
  • Date of issue
    2024

History

  • Received
    28 Nov 2022
  • Accepted
    23 Oct 2023
Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br