Abstract
The most serious heath issue in the world until the early 20th century, when chronic degenerative disease dominated throughout developed countries; is infectious diseases. Globally plagues and cholera have devastated a large portion of populations in European cities, and Sub-Saharan regions in Africa (Barreto, Teixeira, & Carmo, 2006). Globally close to 33.3 million are diagnosed with, and living with the communicable disease, HIV. Of this total an estimated 67% of these individuals live in sub-Saharan Africa. In 2011 this region was said to account for 70% of the total 1.7 million HIV-related deaths for that year. The impact of HIV in this region, and across the globe varies widely, and different settings. An increase in antiretroviral therapy (ART) has been highlighted as an antidote that has the capability of redirecting some of the social economic impacts on patients that have negative effects on the individuals’ families, and communities as well.
Treatment such as ART has created positive ca changes in people’s lives enhancing their life expectancies, fertility, and demographic composition. Community health workers (CHWs) or community health nurses (CHNs) are extremely important to patients who have been diagnosed with HIV in terms of administering palliative care, and patient-centered treatment .These professionals have been instrumental in these settings of epidemiology in terms of reporting, data collecting, data analysis, case finding, and follow-up care. CHNs are integral in performing specific duties, and assume responsibilities. As HIV as an infectious disease has received full attention especially for the World Health Organization (Mwai,  Mburu, Torpey, Frost, Ford & Seeley, 2013).

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Background
According to the Module on Health Education, Advocacy and Community Mobilization, the concept of health refers to a full mental, physical, and social well-being of a person, and not just the absence of disease in in a person’s life. On the other hand, when there is a disturbance in how the body functions normally, this is the definition of disease that can be used interchangeably with the word illness. Diseases can fall in one of two categories; communicable, and non-communicable. Communicable diseases are as result of infectious agents that can be transmitted through humans, the environment, and animals (“Communicable Disease Control, n.d.”), such as HIV. Diseases that do not result from infectious agents, and are not transmitted from person to person are called non-communicable diseases such as cancer, and diabetes (“Principles of infectious disease: Epidemiology II: The Infectious Disease Process, n.d.”).

Communicable Disease Control: Refers to reduction of the prevalence, and incidence of communicable disease to a place where it cannot be seen as a major public health concern. There are three major ways in which communicable diseases can be controlled: 1. Elimination of reservoir; a. Human beings, animals, and non-living things can be reservoirs (“Communicable Disease Control, n.d.”). The Chain of Infection: The mode of transmission in the chain of infection embodies a logical sequence of factors within a chain that are extremely important to the propagation of diseases, and development of infectious agents. Six factors or links are included in the transmission of the chain of infection/disease: 1. Etiological Agent ( a. Metazoa- parasites that cause diseases such as Trichinellosis) b. Protozoa (HIV, diseases immune system is compromised) c. Fungi (such as candidiasis caused by contact with human carriers) d. Bacteria ( Chlamydia/Gonorrhea, etc.) e. Rickettsia (Bacteria found in ticks, lice fleas etc. that cause Rocky Mountain Spotted Fever etc.) f. Viruses (For example, Influenza, human immunodeficiency virus (HIV) g. Prions (chronic wasting disease (CWD) of elk, bovine spongiform encephalopathy (BSE) in cows and< Creutzfeld-Jacob disease (CJD) in humans (“Communicable Disease Control, n.d.”). 2. Reservoir: This is the habitat for infectious. 3. Portal of Exit: This is the route through which the infectious agent escape. 3. Mode of Transmission: Necessary in bridging the gap between the portal exit that leaves the reservoir to the portal of entry leading to the host. 4. Portal of Entry: It is the same portal of entry in the host and out of the reservoir 5. Susceptible Host: Very important link often affected by genetic factors and specific acquired immunity (“Principles of Infectious Disease Epidemiology Module II: The Infectious Disease Process, n.d.”).

The Human immunodeficiency virus (HIV)
Definition: This is a clinical stage infection with the human immunodeficiency virus (HIV). It progressively attacks, and damages organs, immune, and central nervous systems (CNS). In its final stage (HIV-1 and HIV-2), it results in autoimmune deficiency syndrome (AIDS). Epidemiology: The occurrence of HIV in the world, and its widespread nature declare it a pandemic. It is mostly concentrated in the American, southern and western Europe, Sub-Saharan Africa, as well as in Southeast Asia. In Africa, specifically in Ethiopia according to a MOH report in 2002, the HIV prevalence rate for the entire country is about 6.66%, 13.7% in urban areas, and 3.7% in rural areas, HIV appears to be the driving force behind high rates of TB documented in that African regions observed in individuals 15-24 years of age (Barreto,  Teixeira, & Carmo, 2006). Humans Mode of transmission: HIV is primarily transmitted through sexual encounters where blood, and tissues are exposed; however, it can be passed on from an infected mother to the fetus (trans placental transmission). Typically the time from which a person is infected until AIDS is fully developed can be as soon as less than 1 year or as long as 10 years or more: close to 50% of infected adults will have full blown AIDS within 10 years after becoming infected. Period of communicability-shortly after being infected and last for a lifetime. Susceptibility and resistance- if the infected person has other STDs especially ones with ulcers, then susceptibility for HIV increases. Clinical manifestations: About 3-6 weeks after exposure, the infection can be detected. Typically an infected person can suffer from but not limited to “fever, pharyngitis, lymphadenopathy, head ache, retro-orbital pain, arthralgias, myalgias, lethargy or malaise, anorexia, weight loss, nausea or vomiting or diarrhea, Meningitis, Encephalitis, peripheral neuropathy, myopathy, erythematous maculopupular rash, mucocutaneous ulceration” (Barreto,  Teixeira, & Carmo, 2006, p. 193). Late complications of HIV infection: Infected persons might fall ill due to pneumocystis carinii pneumonia, tuberculosis, or cryptococcal meningitis, etc. Diagnosis: Serologic tests can be performed in either the early or late stages, but clinical ground in the late stage. Treatment: There is no one treatment, but typically treatment modalities are developed, and implemented to treat the opportunistic infections like TB, and meningitis. Anti-HIV drugs can be used, but only to reduce the virus being transmitted from infected mother to fetus (preventing fetal infection). Prevention and control: The best way for people to prevent being infected is to take precautionary measures as they would to prevent other types of STDs (Barreto,  Teixeira, & Carmo, 2006).

Determinants of Health: There are quite a few factors that are associated with the current health status of individuals. Factors can either encompass social, biological, psychosocial or even socioeconomic agents, and from these scientists, ad researchers have named five determinants of health in a population: 1. Biology & Genetics such as a person’s sex, and age; 2. Individual Behavior as in whether a person abuses substances such as alcohol, smoking or illegal substances which intravenously enter the body (needles) or through unprotected sexual encounters; 3. Social environment which could be affected by gender & income, 4; Physical Environment such as where a person lives, and if it is overcrowded suggesting possible unsanitary conditions, and 5; Health Services as in how easy is it for a person to access quality health care whether this person has or does not have health insurance (“NCHHSTP Social Determinants of Health, n.d.”). When infected individuals interact with their physical and social environments already poor health outcomes worsen.

The Epidemiologic Triangle: Scientists, and researchers have developed this model called ‘Epidemiologic Triangle’ to study problems related to health. It is instrumental in helping professionals, and students alike to get a better understanding of how infectious diseases spread, and facts about them. Mathematically a triangle has three corners, which are called vertices, and so the Epidemiologic Triangle has 3 main areas of focus: 1. Agent of the ‘what is the triangle’ tells what causes the disease, 2. Host or the ‘who of the triangle’ that is responsible for harboring the organisms or diseases, and 3. Environment or the ‘where of the triangle’ which are external factors, which cause transmission of the diseases (Understanding the Epidemiologic Triangle through Infectious Disease., n.d.”).

Community Health Nurses (CHNs) or Community Health Workers (CHWs): Our community is comprised of different types of people who make up its population, and who receive services from the local health facilities where they received antiretroviral therapy (ART) (Mwai, Mburu, Torpey, Frost, Ford & Seeley, 2013). CHNs and CHWs have technical skills and knowledge than the broader in order to ensure patients receive high quality community based care. The community can be of more importance in delivery high quality HIV quality services such as dissemination of information, adherence support, counseling , creating a strong referral system, and case finding features (“Community, n.d.”). Case Finding: The healthcare center in the community should actively engage in provider counseling, scale up of HIV testing, and TB screaming once there are community-based structures that are deemed appropriate in place. Case finding is not just about identifying patients infected with HIV, but the need to emphasize the “positive benefits of HIV testing and counselling, including access to treatment, care and support services, as well as receiving feedback on behaviors that promote HIV prevention”(“Community, n.d. p. 3”). Knowledge and literacy of HIV: CHNs are integral in imparting knowledge, and promoting literacy of HIV in the communities to families, caregivers on symptoms, and treatments of opportunistic infections as they present themselves after a diagnosis is given. Adherence to ART: Either through mobile reminders or home visits, these CHNs will support adherent to ART (Mwai, Mburu, Torpey, Frost, Ford & Seeley, 2013). Retention in care: Most studies found better retention of patients accessing HIV care: Mortality: Studies show that CHNs were closely associated with reduced risk of death for example, in Malawi after the patients were on antiretroviral therapy (ART) for 3 years. Data collection, surveillance and reporting: Countries like Kenya are circumventing this of error rates by CHNs when filling out medical records by using mobile technology to capture patient information (information on side effects of drugs, progressions of disease or basis as the patient’s vital signs). Cost: Intervention models where care is administered in the home tends to be cheaper when compared to the ART model involving CHNs, and model of care received in traditional facilities (Mwai et al., 2013).

HIV/AIDS | CDC – Centers for Disease Control and Prevention
The Center of Disease Control (CDC) provides leadership efforts to prevent, research, and surveil HIV as well as pioneering the efforts regarding testing, and development of effective biomedical interventions to reduce the transmission of HIV. It is focused on controlling the epidemic by working with community; state, international, and national partners address the HIV epidemic. The Office of Infectious Diseases National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) is responsibility for HIV prevention efforts (“CDC Responds to HIV/AIDS, n.d.”).

References
  • About the Division of HIV/AIDS Prevention. Retrieved from http://www.cdc.gov/hiv/dhap/about.html
  • Barreto, M. L., Teixeira, M.G., & Carmo, E.H. (2006). Infectious diseases epidemiology.
    J Epidemiol Community Health.
    CDC Responds to HIV/AIDS. Retrieved from http://www.cdc.gov/
  • Centers for Disease Control and Prevention. Achievements in public health, 1900–1999 motor- 48(18), 69–74
    Retrieved from: http://www.cdc.gov/
  • Communicable Disease Control. Retrieved from http://www.cartercenter.org/
  • Mwai, G.W.,  Mburu, G., Torpey, K., Frost, P., Ford, N., & Seeley, J. (2013). Role and outcomes of community health workers in HIV care in sub-Saharan Africa: a systematic review. Retrieved from http://www.jiasociety.org/
  • NCHHSTP Social Determinants of Health. Retrieved fromhttp://www.cdc.gov/
  • Understanding the Epidemiologic Triangle through Infectious Disease. Retrieved from http://www.cdc.gov/