Optimizing adherence to highly active antiretroviral therapy among marginalized, HIV-positive women with comorbid depression: the role of the nurse practitioner

Women represent a growing proportion of new positive HIV tests in Canada and are more likely to experience comorbid depression. This is concerning because comorbid depression is associated with suboptimal adherence to highly active antiretroviral therapy (HAART) and poor HIV disease outcomes. The purpose of this project is to answer the question, What is the role of the nurse practitioner (NP) in optimizing adherence to HAART amongst marginalized, HIV-positive women with comorbid depression? By evaluating current literature this project found that social factors such as poverty, homelessness, food insecurity, post-traumatic stress disorder, stigmatization, gender or racial discrimination and injection drug use are risk factors for both comorbid depression and HAART non-adherence. Effective treatments for depression include cognitive behavioral therapy and pharmacological intervention with antidepressants. The role of the NP was inferred by extrapolating the findings from this literature search with the competencies required of NP practice. NPs have the skills, education and legislated authority to provide collaborative care that addresses the underlying social factors that contribute to comorbid depression and HAART non-adherence. These findings are limited by the scarcity of research conducted with HIV-positive female participants, that investigates NP practice or interventions to address underlying social factors. --leaf ii.