Bibliometric analysis of HIV Nursing Research between 1999 and 2022

doi:10.21203/rs.3.rs-2999581/v1

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Bibliometric analysis of HIV Nursing Research between 1999 and 2022

https://doi.org/10.21203/rs.3.rs-2999581/v1

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published 01 Apr, 2024

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Background: Human immunodeficiency virus (HIV) nursing has become more prominent with the increase in chronic HIV infections. This study examined articles related to HIV nursing to determine how the profession has developed and its future direction.

Methods: HIV nursing-related articles published in the Web of Science core collection between 1999 and 2022 were searched. Microsoft Excel 2010 and VOSviewer were used to identify the contributions of countries, institutions, and authors in HIV related care. Collaborative maps, hot topics, and keywords trends were analyzed using VOSviewer and CiteSpace.

Results: A total of 1513 publications were extracted. A steady increase in articles published between 1999 and 2012 was observed. After 2012, the increase in the number of publications was relatively stable. However, since 2016, a downward trend in the number of publications has occured. The USA, South Africa, and the UK were the leading contributors to publications related to HIV nursing. The University of California (San Francisco, USA), the University of Cape Town (South Africa), and the University of KwaZulu-Natal (South Africa) were three key contributing institutions. William L. Holzemer was the author with the most important publications. AIDS Care was the top prolific journal. "HIV-related stigma", "Antiretroviral therapy and adherence", "mental health", and "social support" were the main topics in HIV nursing research.

Conclusion: Research in HIV nursing has gradually shifted from "HIV infection", "risk factors", and "transmission routes" to "social support", "depression", and "public health".

Bibliometric analysis

CiteSpace

HIV/AIDS

HIV Nursing

Research hotspots

VOSviewer.

Human immunodeficiency virus (HIV) weakens the immune system, leading to acquired immunodeficiency syndrome (AIDS) [1, 2]. An estimated 38 million people are living with HIV/AIDS worldwide. Despite advancements in our understanding of the disease, the infection rates are still high. HIV/AIDS remains a huge social and economic burden [3]. The advent of antiretroviral therapy (ART) has revolutionized the treatment of HIV/AIDS, transforming it from a fatal to a chronic condition [4]. The morbidity and mortality of AIDS have decreased significantly in recent years [5]. This change has shifted the emphasis on managing HIV/AIDS from physicians to nurses [6, 7]. Sanne et al. suggested that nurse-monitored ART can be as effective and safe as doctor-monitored ART [8]. Additionally, due to the rapid spread of HIV/AIDS, workloads for nurse have increased significantly. HIV/AIDS has doubled workloads for nurse in caring for patients in several parts of Africa. The primary responsibilities of nurses to HIV patients constitute four aspects: (A) monitoring the side effects of medications; (B) reducing the incidence of drug-drug interactions; (C) promoting AIDS adherence to therapies; (D) providing specialized symptom management [9]. The nursing profession and nursing research on HIV/AIDS play a crucial role in HIV/AIDS management. In the past decades, several studies on nursing and HIV/AIDS have made remarkable contributions to HIV/AIDS management. Nursing-related research on HIV/AIDS has not been comprehensively analyzed or presented as a frontier.

To fill this knowledge gap, a bibliometric analysis may be suitable. Bibliometric analysis is based on quantitative and qualitative analysis of publications in journals. The advantages of bibliometrics include: (A) bibliometric tools are applied quantitatively (e.g., VOSviewer, CiteSpace, Bibliometric R, etc.) to analyze the scientific knowledge network based on big data, which effectively reduce selection bias; (B) publication trends, leading researchers, institutions, countries, journals, and cooperation network can be identified, highlighting the overview of a field; (C) valuable references at different times can be detected and knowledge network shifting in a particular field can be visualized, which may help researchers design their future research.

To obtain more comprehensive data analysis, CiteSpace and VOSviewer are the most common software used for bibliometric analysis. Several studies analyzed subdomains of Virtual Simulation in Nursing [10] and nursing-related studies of COVID-19 [11]. Therefore, this study used VOSviewer and CiteSpace to obtain an overview and visualize nursing-related HIV/AIDS research. In addition to the study findings, this paper presents several directions for future research.

2.1 Search Strategy and Data Collection

Articles related to HIV nursing published in the Web of Science core collection (WoSCC) between 1999 and 2022 were searched and retrieved. The following search terms were used to perform the search in WoSCC on September 04, 2022: "HIV/AIDS (Topic) or Human Immunodeficiency Virus (Topic) or HIV-1 (Topic) or acquired immunodeficiency syndrome (AIDS) (Topic) AND nurse (Topic)". The search terms were used to identify publications primarily focused on HIV nursing. Only publications in English, including reviews, and articles were searched. All records identified in the initial search were screened for relevance independently by two reviewers (Jiaqi Hao and Jing Liu), beginning from titles, abstracts, and full texts. Disagreements were arbitrated by a third-party (Qian Zhang and Jia Chen). All publications were exported in "Full Record and Cited References" format and used to extract bibliometric parameters.

2.2 Data Analysis

VOSviewer (version 1.6.11, Leiden University, Leiden, Netherlands) was used to extract the following bibliometric parameters: title, keywords, authors, institutions, countries/regions, journals, publication year, total citations (TC), citations per publication (CPP), and cited references. Microsoft Excel 2010 (Redmond, Washington, USA) was used to identify the publication trend of the top contributors (e.g., prolific authors, institutions, countries, and journals). VOSviewer was used to map the collaboration network between authors, institutions, and countries to demonstrate their scientific influence in HIV nursing. CiteSpace (Version 6.1. R1) was used to map the co-cited references network and identify references with high citation bursts. The co-occurrence of author keywords and keywords with citation burst was used to visualize knowledge evolution, hot topics, and potential research frontiers in HIV nursing. In VOSviewer and CiteSpace maps, the size of the node was positively correlated with the number of publications, and the line width was positively associated with their link strength.

3.1 General data

Figure 1 shows the study design and analytical approach. After removing irrelevant articles, 1693 publications were included in the final analysis comprising 7175 authors, 2279 institutions, 109 countries/regions, and 495 journals.

3.2 Publication trend

Figure 2 shows the publication trend. The publication period was classified into three phases (Phase I, 1999–2012; Phase II, 2012–2016; Phase III, 2016–2022). In Phase I, publications gradually increased from 40 to 90 per year. In Phase II, the annual publications were maintained between 100 and 110. After 2016, a downward trend in number of publications was observed, with only 60 publications in 2021 and 36 publications by the first nine months of 2022. In addition, the foremost three publication trends in prolific countries were presented.

3.3 Top contributing countries

Figure 3 shows the top ten most prolific countries and the corresponding collaborative network. The USA ranked first with 819 publications (48.4% of the whole) and 26,474 TC, followed by South Africa (232 publications and 6401 TC) and the UK (154 publications and 4643 TC) (Fig. 3A). For CPP, Kenya ranked first with 40.5 CPP, followed by the USA (32.3 CPP) and the UK (30.1 CPP). VOSviewer module of co-authorship-country was used to present data for international collaborative networks. The 23 prolific countries/regions formed a cooperative network with at least 25 publications. The USA, South Africa, the UK, and China had the most significant nodes with relatively thick links. The highest degree of cooperation and total link strength was observed in the USA (TLS = 355) and cooperated with 22 prolific countries. South Africa (TLS = 250), Canada (TLS = 193), and the UK (TLS = 124) had more vital academic collaborations than the US.

3.4 Top contributing institutions

Figure 4 reveals the most prolific institutions which published at least 20 articles. More than a quarter (27.2%) of the articles in HIV nursing were published by the top ten prolific institutions. The University of California (San Francisco, USA) ranks first with 86 publications, followed by the University of Cape Town (South Africa) with 56 publications and the University of Kwazulu-Natal (South Africa) with 50 publications. Regarding citations, the University of Cape Town (South Africa) ranks first with 2716 TC and 148.5 CPP, followed by the University of California (San Francisco, USA) with 2433 TC and 28.3 CPP, and the University of California (Los Angeles, USA) with 1638 TC and 35.6 CPP. VOSviewer was used to visualize the institution's collaborative network. Figure 4B shows the top 29 prolific institutions grouped into four clusters. The most significant cluster includes institutions from the USA (e.g., the University of California in San Francisco, the University of Washington, the University of California in Los Angeles, and Johns Hopkins University). Additionally, several institutions were from South Africa and Canada (e.g., the University of Cape Town, the University of Kwazulu-Natal, the University of Witwatersrand, and the University of Toronto).

3.5 Top contributing authors

Figure 5 shows the top contributing authors (at least five papers) and the collaborative map. William L. Holzemer (Rutgers State University, USA) with 16 publications, Greeff Minrie (North-West University, South Africa) with 16 publications, and David E. Vance (University of Alabama at Birmingham, USA) with 13 publications were identified as the top three most prolific authors. Regarding citations, William L. Holzemer also ranked first with 726 TC and 45.4 CPP, followed by Greeff Minrie with 622 TC and 47.8 CPP, and Fairall Lara (University of Cape Town, South Africa) with 510 TC and 56.7 CPP. VOSviewer was used to analyze the inter-authors' cooperative network and their active time. Figure 5B shows that 68 authors published at least five articles. Six scholar groups with relatively high collaboration rates were identified: cluster# 1 was centered on Zwarenstein Merrick, Fairall Lara, and Lewin Simon (most of them are from South Africa); cluster# 2 was centered on Greeff Minrie et al. (most of them are from South Africa and USA); cluster# 3 was centered on Suominen Tarja and Valimaki Maritta (most of them are from University of Tampere, Finland); cluster# 4 was centered on Campbell Catherine and Nyamukapa Constance (most of them are from England); cluster# 5 was centered on William L. Holzemer and Allison R. Webel (most of them are from the USA); and cluster# 6 was centered on Wang Honghong and Li Xianhong (most of them are from China and the USA). Additionally, a timeline view was used to present the active time of different authors in this field. Scholars in cluster# 2 and cluster# 3 were engaged in the early stage (average publication year before 2010). Scholars in cluster# 1 and cluster# 4 were involved in the middle stage (average publication year around 2013). Scholars in cluster# 5 and cluster# 6 were active in the late Phase (average publication year after 2015).

3.6 Top contributing journals

Table 1 shows the top ten most cited publications in HIV nursing. Of these, only one publication was a review, and the remaining were original articles. DL Paterson et al. published the most cited paper (2372 TC) in the Annals of Internal Medicine, titled "Adherence to protease inhibitor therapy and outcomes in patients with HIV infection" [12]. In this article, the authors recruited 99 HIV-infected patients to assess the effects of different levels of adherence to therapy on virologic, immunologic, and clinical outcomes. These patients were prescribed a protease inhibitor, used no medication organizer, and received no medications. The results showed that adherence was dramatically correlated with the successful virologic products involved in psychiatric disorders, improving adherence to therapy. Interestingly, they also found that physicians mispredicted patients' adherence (41%), higher than that of nurses (30%), which highlighted the role of nurses in improving the medical adherence of HIV patients. Citations per year could be used to evaluate how much attention the publications have received per year and is an indicator of importance. In 2014, Kann L et al. published the highest cited article (n = 144.6), titled "Youth Risk Behavior Surveillance - United States, 2013." In this article, the authors revealed that nearly half of the US students in high school had sexual intercourse, risking sexually transmitted infections, including HIV [13]. Additionally, the review by Callaghan M et al. has many citations (n = 423 TC, 35.3 citations/year), titled "A systematic review of task-shifting for HIV treatment and care in Africa." The author comprehensively analyzed the task shifting model (delegating physician tasks to lower-level staff, e.g., nurses or substitute health care workers) for antiretroviral therapy scale-up in sub-Saharan Africa. The results showed that task shifting provided high-quality, cost-effective care to more patients than the physician-centered model [14].

Table 1

Top 10 most cited publications
Rank	First Author	Title	Document Type	TC	Citation/year	Journal	Year
1	Paterson, DL	Adherence to protease inhibitor therapy and outcomes in patients with HIV infection	Article	2372	107.8	Ann. Intern. Med.	2000
2	Kann, L	Youth Risk Behavior Surveillance - United States, 2013	Article	1157	144.6	MMWR Surv. Summ.	2014
3	Foxman, B	Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs	Article	1108	55.4	Am. J. Med.	2002
4	Lester, RT	Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial	Article	848	70.7	Lancet	2010
5	Kann, L	Youth Risk Behavior Surveillance - United States, 2015	Article	708	118.0	MMWR Surv. Summ.	2016
6	Aiken, LH	Measuring organizational traits of hospitals: The revised nursing work index	Article	507	23.0	Nurs. Res.	2000
7	Foxman, B	Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs	Article	464	24.4	DM-Dis.-a-Mon.	2003
8	Callaghan, M	A systematic review of task- shifting for HIV treatment and care in Africa	Review	423	35.3	Hum. Resour. Health	2010
9	Myer, L	Common mental disorders among HIV-Infected individuals in South Africa: Prevalence, predictors, and validation of brief psychiatric rating scales	Article	308	22.0	Aids Patient Care STDS	2008
10	Edlin, BR	Toward a more accurate estimate of the prevalence of hepatitis C in the United States	Article	307	43.9	Hepatology	2015

3.7 Analysis of co-citation references

Co-citation analysis was performed using CiteSpace and VOSviewer to examine the scientific paradigms evolution in the HIV-nursing field. As shown in Fig. 6A, this network showed publications with more than 20 citations. Large nodes indicated that the publications received more citations. The red nodes represent an outstanding contribution to this field's development. Important references in sub-domains of this field were connected. For example, "McCann TV, 1998, J ADV NURS, V27, P267 " [15] titled "Educational intervention with international nurses and changes in knowledge, attitudes, and willingness to provide care to patients with HIV/AIDS." This article bridges the knowledge between cluster# 13 (avoidance) and cluster# 6 (knowledge). Moreover, CiteSpace also identified the influential co-cited references at different times. Articles published around 2000 were centered on topics about "avoidance," "HIV disclosure," and "health care workers." Articles published around 2010 were centered on topics about "knowledge," "adherence," "fatigue," "task shifting," and "occupational health." Articles published around 2020 were centered on topics about "HIV stigma," "discrimination," "pollution," and "clinical training." Fig. 6B lists these essential articles and their active time. Furthermore, several articles that received much attention between 2020 and 2022 were identified, including Sanne et al. [8], where a randomized non-inferiority trial was used to verify whether the primary task of administering ART to HIV patients could be shifted from physicians to nurses. The results showed that nurse-supervised ART outcomes for HIV patients were not inferior to physician-monitored treatment. This finding supports the transfer of ART tasks to appropriately trained nurses to monitor ART. A systematic review of task-shifting for HIV treatment and care in Africa was performed by Callaghan et al. [14]. In their study, task-shifting provided high-quality, cost-effective care to more patients than physician-centered care. HIV treatment and care staffing shortages can be addressed through task shifting. Fairall et al.'s findings in South Africa suggested that task-shifting from doctors to primary care nurses is feasible. That task shifting can improve health outcomes and quality of care [6].

3.8 Analysis of keywords

Table 2

Thesaurus
label	replace by
acquired immunodeficiency syndrome	AIDS
aids	AIDS
antiretroviral treatment	antiretroviral therapy
attitudes	attitude
healthcare workers	health care workers
hiv	HIV
hiv infections	hiv infection
hiv/aids	HIV
human immunodeficiency virus	HIV
nurses	nurse

CiteSpace and VOSviewer were used to present important topics and research frontiers in the HIV-nursing field and to analyze keyword co-occurrence. To count the number of keyword occurrences more accurately, a thesaurus was used (Table 2) to merge keywords with similar meanings. For example, acquired immunodeficiency syndrome was replaced by AIDS, and HIV was replaced by human immunodeficiency virus. Finally, 72 keywords that appeared more than ten times were classified into seven clusters (Fig. 7A). The top ten most occurring keywords were "HIV" (n = 674), "AIDS" (n = 203), "nursing" (n = 117), "stigma" (n = 87), "nurse" (n = 79), "attitude" (n = 69), "antiretroviral therapy" (n = 62), and "South Africa" (n = 61). To decipher potential research frontiers in this field, the overlay map of keywords occurrence was generated using VOSviewer, and the keyword citation burst using CiteSpace. Keywords that were frequently used were detected at a particular period. Figure 7B shows the potential hot keywords (yellow) identified using VOSviewer, including "medication adherence," "HIV stigma," "depression," "nursing care," "social support," "aging," and "public health." Fig. 7C reveals the evolution of keywords between 1999 and 2022. The top 47 keywords with the most substantial citation bursts were displayed, showing that "human immunodeficiency virus" had the highest burst strength (n = 16.5). In the early stage, the keywords "stress," "physician," "HIV infection," and "health care workers" received much attention. Keywords such as "student," "AIDS-related stigma," "attitude," "education," and "predictor" also received much attention. In recent years (2015–2022), keywords have received much attention, for instance, "nursing care," "task shifting," "depression," "social support," "public health," and "HIV-related stigma."

4.1 Global publication trend

Bibliometric methods were used in this study to visually analyze 1513 HIV nursing publications between 1999 and 2022, mainly 1336 publications (88.0%) and reviews (8.66%). The number of publications can reflect the activity and productivity in a scientific field over the years. Generally, an upward trend in number of publications in nursing-related HIV/AIDS research was observed. Specifically, three phases were roughly distinguished. The first period was between 1999 and 2012. Since 1980, HIV has increasingly become a global epidemic, with approximately 78 million HIV-positive people and approximately 39 million HIV-related deaths worldwide [16]. Therefore, many scholars have been devoting themselves to studying ways to prevent and control HIV/AIDS.

The second Phase was between 2012 and 2016 when the number of publications stabilized between 90 and 110 per year. Notably, during this Phase, the number of publications in South Africa has increased dramatically since 2007. This finding implied that it was because the South African government began implementing the HIV & AIDS and STI Strategic Plan for South Africa, 2007–2011(NSP) [17]. Therefore, scholars in South Africa began to focus on the disease, leading to an upward trend in publications after 2007. The third stage was between 2016 and 2022. The number of publications gradually decreased to 60 in 2021; since 09/04 in 2022, only 36 papers were published. Considering this publication trend shift, this study examined the potential reasons using the map of knowledge evolution (co-cited reference map, Fig. 6A-B). In 2016, Cohen et al. reported the five-year follow-up results of the HIV Prevention Trials Network (HPTN) 052 trial. The authors showed that early initiation of ART reduces the risk of genetically linked HIV-1 infections in sexual partners compared to delayed initiation of ART (hazard ratio, 0.07; 95% CI, 0.02 to 0.22) [18]. This finding corroborates that ART for HIV treatment should be administered as early as possible [19, 20]. The debate about ART initiation has been resolved. During the COVID-19 outbreak, many scholars shifted from other scientific research to COVID-19 research, reducing the number of HIV nursing research.

4.2 Analysis of countries

Figure 3A shows the top ten prolific countries/regions in nursing-related HIV research. The USA was the dominant country with the most HIV nursing-related publications. Figure 3B reveals the international cooperation map. The USA was also the dominant country on the map having intensive connections with other countries. The previous bibliometric analysis also showed the USA leading in subdomains of HIV/AIDS-related research, such as AIDS-related stigma [21], medication care for AIDS patients [22], and care for children with AIDS [23]. Although ranked 9th regarding the number of publications, Kenya ranked first in CPP. A potential explanation for its high citations is that Kenya's institutions and scholars have published prominent articles in nursing-related HIV research. Kenya's most cited article was published in Lancet in 2010, in collaboration with the USA and Canada, titled "Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomized trial". The principal author was Richard T, whose main content was improving medication adherence in HIV patients (Article IF:202,731) [24]. Furthermore, the top three cited articles from Kenya were published in collaboration with multi-countries [25–26]. A previous study reported the number of people with HIV infection in Kenya increased gradually [27], which attracted further research worldwide. The evidence of Kenya's central role in HIV nursing research is shown in Fig. 3B. That is, Kenya has intensive connections with several prolific countries.

The citation of international cooperative publications was higher than isolated studies. Cooperation between different countries can provide more comprehensive thoughts [28]. It was suggested that countries could use a multi-country collaborative approach for future research. Developed countries can collaborate with developing countries to alleviate medical conditions where their research lags.

4.3 Analysis of institutions

As shown in Fig. 4, the University of California (San Francisco, USA) was ranked first with 86 publications, which also corroborated the dominating role of the USA in nursing-related HIV research. University of Cape Town (South Africa) was the second most prominent institution with 56 publications, followed by the University of Kwazulu-Natal (South Africa) with 50 publications. Figure 4B shows the connections between the top 29 prolific institutions in HIV nursing, which were grouped into four clusters. Notably, institutions from South Africa (the University of Cape Town and the University of Witwatersrand) closely partner with American institutions (Johns Hopkins Univesity and the University of Washington). Most of their co-authored papers were published in AIDS and Behavior, Lancet, and BMJ Open. [29–31] Most of their research has focused on the clinical presentation of HIV patients and the impact of HIV on primary health care.

Furthermore, the University of Washington (USA) and the University of California (San Francisco, USA) established an intensive collaborative partnership early. These Universities have contributed to mother-to-child transmission of HIV and antiretroviral therapy (ART) for HIV/AIDS research [32–33]. A study on ART found that the risk of HIV transmission was reduced by 1% after initiating ART. This finding suggested that ART should be initiated early in HIV patients to minimize human HIV transmission, and antiretroviral treatment steps should be made widely available to HIV-infected patients [34].

Intensive collaborations between South Africa and the United States in AIDS research have been successful. Thus, partnerships between institutions in different countries are recommended in future research.

4.4 Analysis of authors

Figure 5 shows the top ten contributing authors (at least five papers) and the collaborative network among prominent authors. William L. published the most significant articles (n = 16) with the most citations (n = 726). In the early years, William L.'s research focused on nursing and medication adherence of HIV patients [35–36]. Gradually, his research shifted to self-care to chronic disease [37] and the quality of life of HIV patients [38]. In 2009, William L's research focused on HIV-related stigma because of the high stigma arising from social discrimination against HIV [35, 39, 40]. William L's study remained as social stigma and health care of HIV patients in 2021 and 2022 [41, 42]. Greeff Minrie (North-West University, South Africa) was ranked second with 13 publications and 622 TC. She also performed many studies on HIV stigma [40, 43–49]. Among her research findings, an article with the terms "Eating plastic," "Winning the lotto," and "Joining the WWW" describing HIV/AIDS in Africa has been cited mostly [49]. The descriptions showed many negative labels and beliefs about HIV. This article was published in the JANAC-Journal of nurses' association in AIDS care. David E. Vance (Univ Alabama Birmingham, USA) was the third most prominent author. He focused on the elderly population living with HIV in his early research [50–52]. Since 2010, his research has shifted to complications of HIV [53, 54]. Recently, he has been recognized in the neurological aspects of HIV/AIDS research [55–57].

Figure 5B shows six scholar groups with relatively higher collaborations, determined among 68 prominent authors. Authors within clusters 2 and 3 studied HIV nursing earlier (the average publication year was before 2010). Cluster 3 was centered on Suominen Tarja and Valimaki and Maritta. Most of them are from the University of Tampere (Finland). Valimaki and Maritta's research mainly focused on nurses' knowledge and attitudes to HIV/AIDS [58, 59]. Valimaki and Maritta's research has involved close collaborations with Central South University (China) [60]. Notably, a Chinese scholar, Wang Honghong, was ranked 10th with nine publications. Her research focused on high-risk sexual behaviors, quality of life, and psychological issues of men who have sex with men (MSM), a particular population vulnerable to HIV/AIDS [61, 62].

4.5 Analysis of keywords and research frontiers

The keywords (co-occurrence analysis and co-cited references) are used to visualize knowledge networks and research in frontier areas. Keywords provide a quick insight into a particular research area. In the previous 20 years, the top ten most frequently used keywords were "HIV," “AIDS,” “nursing,” “stigma,” “nurse,” “attitude,” “antiretroviral therapy,” “south africa,” “knowledge,” and “adherence.” The significant keywords generated using the VOSviewer keyword co-occurrence characterized the knowledge structure of HIV nursing research. The top five most important clusters represented the entirety of HIV nursing, indicating that the psychological status of HIV patients, antiretroviral therapy, and medication adherence are major research hotspots. In the following section, these new keywords are discussed in detail.

4.5.1 Cluster 1 (Red): HIV Stigma

The HIV stigma was the most significant cluster accounting for 38.4% of the total keywords. The primary keywords in this cluster were "HIV (n = 674), stigma (n = 87), social support (n = 16), discrimination (n = 21), and home-based care (n = 11)". HIV stigma was the main topic in this cluster [63] [64]. Zhu's results suggested that perceived discrimination by HIV patients is related to self-reported cognitive ability [65]. Zhao showed that HIV stigma is also associated with family and social support [66], suggesting that counseling services and support systems should be developed to reduce discrimination regarding the disease.

Further research and interventions in HIV nursing to reduce HIV stigma strengthen the focus on family response and social support. Studies showed that stigma affects the quality of life of people living with HIV (PLWH), and reducing stigma effectively improves the health status of HIV-infected patients through several interventions [67]. Currently, there are three intervention models for reducing HIV stigma. For instance, Kiene et al. implemented home-based HIV counseling and testing (HBHCT) in sub-Saharan African countries to reduce HIV stigma, improve treatment outcomes, and reduce mortality [68]. HBHCT can reduce HIV incidence by impacting individual and population viral loads. Those who received HBHCT intervention were more likely to achieve viral suppression within 12 months and shorter times for HIV care and ART. Root et al. [69] proposed a community home care (CHBC) program for HIV patients. They found that CHBC can provide continued guidance and encouragement for ART adherence, reported by 92 percent of participants with improved health due to the involvement of care supporters. Thirty-one percent of participants started ART after interventions from care supporters. More than a quarter of participants (27.9%) sought HIV testing after the intervention, and 53% reported that they would have died if care support was absent. In contrast, Ameh et al. [70] believed that CHBC increases community stigma against HIV because family caregivers visit the homes of HIV patients. Thus, they introduced the integrated chronic disease management (ICDM) mode in South Africa, which has helped reduce HIV stigma.

In conclusion, strengthening the social popularization of HIV, focusing on the psychological condition of HIV patients, and improving the supervision and management mechanism of medical workers to reduce the HIV stigma are highly recommended.

4.5.2 Cluster 2 (Green): High-risk Groups in HIV Nursing

The second cluster refers to high-risk groups in HIV nursing, and they account for 16.4% of the total keywords. The primary keywords in this cluster are “aids (n = 203), women (n = 35), and hiv infection (n = 25), men who have sex with men (n = 13), risk factors (n = 12),”. Women and children are the most at risk of HIV infection in Africa [71]. Balkus et al. [72] developed an HIV infection risk assessment tool for African women in 2016. This scoring tool achieved good predictive power and hence can be applied in various settings to identify women at high risk for HIV infection in future year. Ayton et al. [73] investigated the HIV infection risk among adolescent girls. This work developed targeted interventions and effective prognostic tools for adolescents in high-risk settings. Pintye et al. [74] explored the maternal HIV risk and developed a risk assessment tool for this population. Using this tool, it is possible to predict the HIV risk for the pregnant population and identify priority groups of pregnant women who may need pre-exposure prophylaxis (PrEP). Based on the African female risk assessment, Willcox et al. [75] developed a risk assessment tool for clandestine prostitutes. This tool showed good potential for targeted PrEP promotion among higher-risk female sex workers (FSW).

In 2009, Menza et al. [76] developed a risk assessment model for the men who have sex with men (MSM) for the first time. Since then, several other scholars, Smith [77], Hoenigl [78] and Scott [79] formulated risk assessment models for MSM under different research settings. Among these models, the HIRI-MSM (HIV Incidence Risk Index for Men who have Sex with Men) model was later validated by Wilton et al. [80]. HIRI-MSM can identify potential candidates for PrEP among men who have sex with men using an HIV risk screening tool. HIRI-MSM has also been validated in Toronto with good outcomes and deserves further validation and promotion. The HIV infection risk assessment tool can provide timely intervention for high-risk HIV infection populations hence reduce the rate of HIV infection.

In future, the range of HIV knowledge, especially for high-risk populations, should be expanded through research. HIV infection risk assessment tools should be developed for different high-risk groups to achieve overall reduction in HIV infection rate.

4.5.3 Cluster 3 (Yellow and Purple): Health Promotion in HIV Nursing

This cluster refers to HIV nursing health promotion, which accounts for 17.3% of the total keywords. The primary keywords in this cluster are "nursing (n = 117), and HIV prevention (n = 17), HIV testing (n = 12), health promotion(n = 10)". The primary keywords in the purple cluster are "South Africa (n = 61), qualitative research (n = 34), epidemiology (n = 14), primary health care (n = 14), mental health (n = 14)". As with many other sexually transmitted diseases, there is currently no vaccine available that effectively prevents HIV. [81]. However, HIV has become a chronic disease that is controlled by antiretroviral therapy, and the potential HIV risks can be reduced by strengthening primary healthcare interventions [82]. Thus, the essential parts of HIV care are HIV prevention and HIV testing.

South Africa is the most affected region by HIV, and many researchers have intensified research in this country, particularly to develop HIV prevention instruments [83]. Several researchers have shown that the most effective HIV prevention tool is antiretroviral pre-exposure prophylaxis [19, 84]. Karim et al. [85] found that tenofovir gel (an antiretroviral microbicide) can decrease the incidence rate of HIV by 54% in people who adhere to the drug. Calum's study showed that 1% tenofovir gel reduced HIV-1 infections by 39% [86].

Apart from preventive tools, the HIV testing rate is considered an important components of HIV prevention and treatment strategies. Although HIV morbidity and mortality can be reduced by ART, many people are still not professionally tested for HIV and do not receive antiretroviral treatment in time [87]. This phenomenon is caused by low public awareness of the risk of HIV infection. Musheke et al. postulated that the psychological burden of HIV patients limits HIV testing efforts [88].

The lower rates of HIV testing have resulted in insufficient access to ART, resulting in a lower rate of timely HIV treatment in many people. Several researchers have suggested that the HIV testing population should be expanded to include family members of HIV patients. Furthermore, expanding the testing population can significantly prevent mother-to-child transmission [89], MSM sexual transmission [90] and other transmission routes. A critical factor for increasing HIV testing rates in couples is HIV testing. The results of Musheke [91] showed that HIV testing for couple helps to disclose HIV status to marital partners, promotes safer sex, and allows the provision of treatment and HIV nursing in a timely manner. Carey et al. [92] showed that the people who attended staged behavioural counselling (SBC) with a nurse were more willing to undergo HIV testing relative to those who used educational digital video, thus SBC can increase the HIV testing rate.

HIV prevention and HIV testing can effectively reduce the incidence and infection rate of HIV. In the future, there is a need to improve primary health nursing and increase HIV testing and prevention measures.

4.5.4 Cluster 4 (Orange): HIV Nursing Improves Medication Adherence

The primary keywords in this cluster are “antiretroviral therapy (n = 62), adherence (n = 46), and ART (n = 11), treatment (n = 11)”. Under this cluster, scientists have focused on HIV nursing to improve medication adherence. Lester et al. [24] compared medication adherence in HIV patients between the standard care group and the mobile phone short message service (SMS) intervention group. The most important component of SMS is reminding patients to receive antiretroviral therapy while asking about their status, thus alerting them to the availability of telephone support. These results demonstrates that ART adherence and viral suppression increases in patients receiving SMS support. The study by Kelly et al. [93] also showed that SMS is the best method to achieve ART and improve medication adherence for HIV patients in areas with limited healthcare personnel. SMS effectively reduces the number of missed medications for HIV patients. The patients who received medication instruction and HIV knowledge through SMS develop positive attitudes toward medicine and significantly have fewer treatment interruptions [94]. Griffee et al. [95] compared SMS and a combination of SMS-based support groups, home visits and clinic-based counselling. It was found that the multi-layered intervention positively improved medication adherence among HIV patients. The Multi-level intervention improved medication adherence among HIV patients significantly [96, 97].

Pugh et al. [98] conducted a systematic review of nursing interventions to improve medication adherence among HIV patients in sub-Saharan African countries. The researchers found that community-based interventions were the most effective, strategies especially home-based ones. By conducting multi-level interventions, HIV patients record positive outcomes in terms of long-term adherence to antiretroviral therapy. Besides SMS intervention, Brown et al. [99] demonstrated that family support facilitated ART initiation and promoted medication adherence among HIV patients. This finding was corroborated by the study by Pugh [98]. However, some women expressed concerns about SMS and family support, especially if they were concerned that their partner would not consent to the use SMS. These findings were common among women who did not disclose their status [100].

Generally, rapid initiation of antiretroviral therapy and timely medication adherence are essential parts of HIV nursing [101]. We call for healthcare workers to pay more attention to patients' medication adherence to improve HIV patients' medication adherence and quality of life, through continuous health education and treatment supervision using mobile health care tools, such as SMS and family support.

This study has several limitations that should be acknowledged. First, the papers on virtual simulation in HIV nursing were retrieved based on the WoSCC. Although WoSCC is acknowledged as a highly authoritative database, scientists also widely acknowledge the credibility of PubMed, Scopus, and Google Scholar. Second, the number of citations and citations per paper is affected by time, and hence it is still controversial whether it is a comprehensive indicator of the quality of an article or author. In addition, the journal's influence was not solely determined by the quantity of publications, but rather by other indicators. Third, we included only English papers in this study. Finally, database updates may cause discrepant results.

This bibliometric analysis identified prominent contributing authors, institutions, countries/regions, journals and geographical distribution of HIV nursing research. The research hotspot is gradually shifting from the clinical nursing characteristics of HIV disease to the psychological nursing aspects of HIV patients. The following are the directions for future research: 1. Enhance cooperation between authors, research institutions and countries. 2. Strengthen primary health care and increase HIV testing and prevention measures. 3. Expand the scope of HIV knowledge and increase awareness of HIV-related knowledge to reduce HIV stigma. 4. Pay attention to the psychological condition of HIV patients to make HIV nursing no longer just physical care. 5. Develop more intervention methods which can promote HIV patients' medication adherence and add viral load measurement into the outcome indicators to validate intervention effects.

Author Contributions

All records identified in the initial search were screened for relevance independently by two reviewers (Jiaqi Hao and Jing Liu), beginning from titles, abstracts, and full texts. Disagreements were arbitrated by a third-party (Qian Zhang and Jia Chen).

Acknowledgment

We thank all of the global researchers, medical staff and health practitioners who have contributed to the HIV.

Availability of data and materials

All the data analyzed and reported in this paper were from published literature, which is already in the public domain.

Funding

The research described in this paper was supported by the Hunan Science and Technology Innovation Platform and Talent Plan, China (Grant number 2017TP1004).

Ethics approval and consent to participate: Not applicable.

Consent for publication: Not applicable.

Competing interests: The authors declare that the research was conducted in the absence of any commercial or fnancial relationships that could be construed as a potential conflict of interest.

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No competing interests reported.

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Bibliometric analysis of HIV Nursing Research between 1999 and 2022

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Abstract

Figures

1. Introduction

2. Materials and Methods

2.1 Search Strategy and Data Collection

2.2 Data Analysis

3. Results

3.1 General data

3.2 Publication trend

3.3 Top contributing countries

3.4 Top contributing institutions

3.5 Top contributing authors

3.6 Top contributing journals

3.7 Analysis of co-citation references

3.8 Analysis of keywords

4. Discussion

4.1 Global publication trend

4.2 Analysis of countries

4.3 Analysis of institutions

4.4 Analysis of authors

4.5 Analysis of keywords and research frontiers

4.5.1 Cluster 1 (Red): HIV Stigma

4.5.2 Cluster 2 (Green): High-risk Groups in HIV Nursing

4.5.3 Cluster 3 (Yellow and Purple): Health Promotion in HIV Nursing

4.5.4 Cluster 4 (Orange): HIV Nursing Improves Medication Adherence

5. Limitation

6. Conclusion

Declarations

References

Additional Declarations

Supplementary Files

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