Epidemiology paper 1

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Communicable Diseases Epidemiology Paper
Janelly Perez Font
Grand Canyon University
March 31, 2022
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Communicable Diseases Epidemiology Paper
Communicable diseases are prevalent globally and contribute to high mortality and
morbidity rates. Communicable diseases are illnesses caused by bacteria or viruses that spread
from one person to another through contact with bodily fluids, contaminated surfaces, insect
bites, blood products, or through the air (Edemekong & Huang, 2022). There are numerous
communicable diseases, some of which necessitate reporting to relevant government agencies or
health departments within the area of the outbreak. According to the World Health Organization
(2021a), the most common communicable diseases include cholera, tuberculosis, hepatitis A, B
& C, HIV/AIDS, measles, salmonella, leprosy, influenza, yellow fever, and smallpox. The most
common modes of transmission include sexual intercourse, fecal-oral, insect bites, food, and
contact with contaminated surfaces, droplets, fomites or skin contact (Edemekong & Huang,
2022). This epidemiology paper focuses on Human Immunodeficiency Virus (HIV).
Description of the Disease
Human Immunodeficiency Virus (HIV) is a major public health problem globally. HIV is
an infection that attacks an individual’s immune system, specifically the CD4 cells (WHO,
2021b). The virus attacks the body’s CD4 cells and weakens a person’s immunity against other
infections. If a person has a CD4 cells count below 200, their immune systems become
compromised and the victim becomes vulnerable to infections such as tuberculosis and other
forms of cancer. According to WHO (2021b), someone with a CD4 count below 200 is described
to have Acquired Immunodeficiency Syndrome (AIDS). HIV is transmitted through sexual
intercourse or blood contact with an infected person via shared needles or injections (Mayo
Clinic, 2022). It can also be spread from mother to child during breastfeeding, pregnancy, or
childbirth. Underlying sexually transmitted infections such as herpes, syphilis, gonorrhea,
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chlamydia, and bacterial vaginosis are also identified as risk factors (WHO, 2021b). Sharing
contaminated syringes, needles, and other injecting equipment for drug abuse or during blood
transfusion, tissue transplantation, and other medical procedures can increase the risk of
infection. Among healthcare workers, accidental needle stick injury can lead to HIV infection.
The signs and symptoms of HIV vary depending on the stage of infection. In the initial
stages, a person may experience fever, rash, headache or sore throat (WHO, 2021b). As the
infection persists, they may develop lymph nodes, fever, cough, diarrhea, and weight loss.
Without treatment, victims may develop other complications such as tuberculosis, severe
bacterial infections, Cryptococci meningitis, lymphomas and Kaposi’s sarcoma (WHO, 2021b).
Other complications include wasting syndrome, kidney disease, liver disease, and neurological
complications. Currently, the is no vaccine to prevent HIV and no cure for HIV/AIDS; however,
the viral load of HIV can be managed and suppressed by antiretroviral (ARV) drugs (WHO,
2021b).
Since 2016, the World Health Organization recommended that all individuals living with
HIV be given lifelong antiretroviral therapy (ART), including adults, adolescents, children,
pregnant and breastfeeding women, irrespective of health status or CD4 cell count (WHO,
2021b). As of June 2021, 187 countries had implemented this recommendation, covering 99% of
all persons living with HIV worldwide. Along with this treatment requirement, WHO also
recommends a rigorous ART initiative for all persons living with HIV, including providing
antiretroviral therapy on the same day of diagnosis (WHO, 2021b)? By July 2021, 82 countries
reported a nationwide implementation of this initiative and globally approximately 28.2 million
people with HIV had received ART.
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HIV is highly prevalent globally, with an estimated 37.7 million people living with the
virus at the end of 2020, of which two-thirds (25.4 million) are in the WHO Africa Region (Who,
2021b). In 2020, approximately 680,000 people succumbed to the disease and 1.5 million people
contracted HIV. HIV is a reportable disease because of public health importance. According to
Medline Plus (2021), all local, state, and national agencies such as county and state health
departments are required to report to the CDC diseases, when diagnosed by doctors or
laboratories.
Social Determinants of HIV
Various social determinants influence the development of HIV. According to Gant et al.
(2019), social determinants of health are existing social structures and economic systems that
influence health inequities. The CDC has identified homelessness, level of poverty, insurance
coverage, less than high school education, level of urbanization, and percentage of people living
in rural areas (CDC, 2018). Most of these determinants are correlated. For example, less than a
high school education is associated with poverty and low income in the United States (Gant et
al., 2018). Individuals living below the poverty line are likely to be homeless, uninsured, and
living in rural areas. They are also at risk of practices such as illegal injection of drugs, sexual
promiscuity, and homosexuality, which are also HIV social determinants. As the level of
education increases, diagnoses increase and individuals are encouraged to take preventive and
other treatment measures to prevent the spread of the disease (Gant et al., 2018). However, those
who are not educated may be reluctant to seek treatment, which exposes them to other infections
and the spreading of the virus to unsuspecting partners. According to Sprague and Simon (2021),
most populations with a disproportionate burden of HIV are the poor, minority ethnic, racial, and
sexual groups. The HIV epidemic not only affects individuals’ health, but it also impacts
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households, communities, and the growth, development, and economic growth of countries. It is
no coincidence that most countries burdened by HIV struggle with food insecurity and other
infectious diseases.
Epidemiologic Triangle of HIV
Various models for determining disease causation have been conceptualized. One of the
simplest models is the epidemiologic triangle or triad. According to Zena (2019), the triangle
consists of an external agent, a vulnerable host and an environment that links the agent and the
host. The interaction between these factors produces disease. The agent is an infectious
pathogen, microorganism, parasite, microbe, bacterium, or virus. In this case, HIV attacks the
CD4 cells and weaken the immune system of a person (WHO, 2021b). The agent must be present
for a disease to occur. The agent depends on the host to replicate and survive. The host refers to
human beings that get infected by the disease (Zena, 2019). Various factors intrinsic to the host
can impact a person’s exposure, vulnerability, and response to the external agent. These factors
include hygiene, sexual practices, gender, age, genetic composition, immunologic status,
presence of disease, nutrition, anatomic structure, and psychological makeup (Zena, 2019). HIV
can be transmitted from one person to another through sexual intercourse, bodily fluids and
blood contact with an infected person or via shared needles or injections with an infected person
(Mayo Clinic, 2022). Lastly, the environment entails the extrinsic factors (the social, cultural,
and political milieu) that affect the agent and the opportunity for exposure (Zena, 2019). Socioeconomic factors such as poverty, level of education, homelessness, insurance coverage, level of
urbanization, and percentage of people living in rural areas as risk factors for HIV (CDC, 2018).
Other trigger factors such as stigmatization, illegal injection of drugs, and lack of adequate
counselling can influence the spread of the virus.
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Role of the Community Health Nurse
Community health nurses play a central role in navigating epidemics and promoting
healthy practices within the community. Their roles range from case finding, reporting, data
collection, data analysis and follow-up. In terms of case finding, the nurses play a critical role in
contact tracing, linking them to care, accompanying patients to clinic appointments, providing
psychosocial support, and referrals (Busza et al., 2018). The nurses also advocate for increased
access to HIV prevention within the community, early diagnosis, and access to treatment
opportunities. The nurse has a mandatory role in reporting every new case. According to Medline
Plus (2021), all local, state, and national agencies such as county and state health departments are
required to report to the CDC diseases, when diagnosed by health care workers.
This reporting process plays a critical role in data collection, analysis, and follow-up.
Once the nurses identify people living with HIV, nurses play a central role in raising awareness
on HIV prevention, safe sex practices, referrals to professionals and clinics, nutrition that boosts
the immune system and follow up on newly diagnosed persons (Busza et al., 2018). The nurses
must consider the cultural and socio-economic status of the patients within the community to
promote engagement and empathy. Nurses can also provide access to well-being products and
services such as condoms, pregnancy checks, ARVs, nutritional support, and counselling
services (Wood et al., 2018). While doing so, they also collect demographic data that is used for
analysis and intervention development. Demographic data is important in community health
improvement. Demographic data include gender, age, income status, sexual orientation, lifestyle,
employment status, and underlying conditions. According to Berg (2018), demographic data is
used to inform treatment plans. This information is collected through a standardized process such
that it can be utilized to ensure patients attain optimal treatment outcomes. Demographic data is
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also used to determine the population needs of the community and develop intervention plans
tailored to meet the needs of the community.
National Agency/Organization that Addresses HIV
There are various nongovernment agencies engaged in the global response and
management of HIV/AIDS. The first agency identified is the International AIDS Society (IAS),
which is the largest organization with HIV professionals and members from over 170 countries
(HHS, 2021). The association promotes the implementation of evidence-based and human rightsbased approaches for improving the lives of people living with and vulnerable to HIV infection.
The agency has various campaigns and programs, shapes the evidence base, harnesses the
research, and augments the plight of vulnerable communities to shape policy for HIV prevention
(HHS, 2021). Additionally, its advocates, support capacity building, and partner with civil
society groups, support capacity building, and communities globally. It hosts numerous HIV
conferences such as HIV Research for Prevention Conference, the IAS Conference on HIV
Science, and the International AIDS Conference focused on health improvement.
The second agency is the World Health Organization (WHO), which is a United Nations
agency that connects countries, partners, people to promote the wellbeing, health and safety of
vulnerable individuals globally (HHS, 2021). Within the organization is the Department of
Global HIV, Hepatitis and STIs programmes that strives to develop and implement strategies to
eliminate these three communicable diseases as health concerns. The department devises
evidence-based procedures and offers technical support to solve public health concerns and
challenges associated with HIV, Hepatitis, and STIs.
The last agency identified is the Joint United Nations Programme on HIV/AIDS
(UNAIDS). It is an international agency that strives to end AIDS as a public health threat by
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2030 in line with the SDGs (HHS, 2021). It also offers technical support, advocacy, strategic
direction, and coordination to help connect governments, NGOs, and local communities to
deliver life-saving interventions and services. The organization gathers strategic information and
insights to enhance the understanding of HIV prevalence and progress made at the local,
national, regional, and global levels (HHS, 2021). It also partners with WHO, UNICEF,
UNHCR, UNDP, WFP, UNODC, UNESCO, UNFPA, ILO, UN Women, and the World Bank to
realize its goal.
Global Implication of HIV
HIV is a global public health problem. It presents numerous implications, including the
vulnerability to develop other infections such as tuberculosis, severe bacterial infections,
Cryptococci meningitis, lymphomas and Kaposi’s sarcoma (WHO, 2021b). Other complications
include wasting syndrome, kidney disease, liver disease, and neurological complications. HIV is
highly prevalent globally, with an estimated 37.7 million people living with the virus at the end
of 2020, of which two-thirds (25.4 million) are in the Sub-Saharan Region (Who, 2021b). HIV is
the leading cause of death in the world with over 36.3 million deaths so far and 680,000 deaths
recorded in 2020 (WHO, 2021b). The HIV epidemic not only affects individuals’ health, but it
also impacts households, communities, and the growth, development, and economic growth of
countries. Most countries burdened by HIV also struggle with food insecurity and other
infectious diseases. According to Ojo et al. (2022), successful HIV management is based on
proper nutrition as a critical component of the treatment protocol because good nutrition
facilitates a positive immune response to ART. Food security and low income contribute to
wasting and weight loss, which becomes a risk factor for mortality and HIV progression (Ojo et
al., 2022). Food security is a strong predictor of comorbidities such as active tuberculosis.
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References
Berg, S. (2018). Improve health equity by collecting patient demographic data. American
Medical Association. Retrieved from https://www.ama-assn.org/deliveringcare/population-care/improve-health-equity-collecting-patient-demographic-data
Busza, J., Dauya, E., Bandason, T., Simms, V., Chikwari, C. D., Makamba, M., … & Ferrand, R.
A. (2018). The role of community health workers in improving HIV treatment outcomes
in children: lessons learned from the ZENITH trial in Zimbabwe. Health Policy and
Planning, 33(3), 328-334.
CDC. (2018). CDC Adds New HIV and Social Determinants of Health Indicators to
NCHHSTP’s AtlasPlus. Retrieved from
https://www.cdc.gov/nchhstp/dear_colleague/2018/dcl-061818-AtlasPlus.html
Edemekong, P.F. & Huang, B. (2022). Epidemiology of prevention of communicable diseases.
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
Gant, Z., Dailey, A., Hu, X., Wu, B., Jin, C., Yu, C., … & Friend, M. (2019). Social determinants
of health among adults with diagnosed HIV infection, 2017. HIV Surveillance Report:
Supplemental Report, 24 (4).
HHS. (2021). Global HIV/AIDS Organizations. HIV.org. Retrieved from
https://www.hiv.gov/federal-response/pepfar-global-aids/global-hiv-aids-organizations
Mayo Clinic. (2022, March 26). HIV/AIDS. Retrieved from
https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc20373524
Medline Plus. (2021). Reportable Diseases. Retrieved from
https://medlineplus.gov/ency/article/001929.htm
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Ojo, T., Ruan, C., Hameed, T., Malburg, C., Thunga, S., Smith, J., … & Peprah, E. (2022). HIV,
Tuberculosis, and Food Insecurity in Africa—A Syndemics-Based Scoping
Review. International Journal of Environmental Research and Public Health, 19(3),
1101.
Sprague, C., & Simon, S. E. (2021). Ending HIV in the USA: integrating social determinants of
health. The Lancet, 398(10302), 742-743.
Wood, E. M., Zani, B., Esterhuizen, T. M., & Young, T. (2018). Nurse-led home-based care for
people with HIV/AIDS. BMC Health Services Research, 18(1), 1-13.
World Health Organization. (2021a). Communicable diseases. Retrieved from
https://www.afro.who.int/health-topics/communicable-diseases
World Health Organization. (2021b). HIV/AIDS. Retrieved from https://www.who.int/newsroom/fact-sheets/detail/hiv-aids
Zeni, M. B. (2019). Principles of Epidemiology for Advanced Nursing Practice: A Population
Health Perspective: A Population Health Perspective. Jones & Bartlett Learning.
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