<p> HIV infection is a leading cause of morbidity and mortality in our country today with nearly 1.2 million Americans living with HIV infection. Early recognition of infection is imperative for appropriate initiation of treatment to prevent comorbidities. Additionally, identification of infection can serve as a primary preventative measure to reduce spread of the disease. National organizations have supported the initiation of routine screening policies for HIV in health care settings. Primary care providers are uniquely positioned to be able to offer HIV screenings and identify infected persons very early in the course of the disease. Despite support for routine testing in the literature and by national evidence-based guidelines, testing is still not offered routinely in the primary care setting. The purpose of this project was to explore if a clinical reminder improves the frequency of HIV screening offered in a rural primary care clinic (PCC) located in Central Louisiana. Results of the project did show a statistically significant increase in the frequency of HIV screening offered following implementation of the clinical reminder system.</p>

<p> This dissertation, composed of three manuscripts, provides a foundation for sleep disorders screening in primary care. The first manuscript presents a concept analysis of sleep to guide nurses&rsquo; understanding of how sleep impacts patients. The first manuscript is currently under review in the Nursing Forum journal. A framework for sleep disorders screening in primary care is presented, and followed by a systematic review of the literature to identify questionnaires that might be suitable to screen for sleep disorders in primary care. Several candidate questionnaires are identified, but none of those meet both thoroughness and brevity criteria postulated as necessary for use in primary care practices. The second manuscript is currently under review in Sleep Medicine Reviews. The third manuscript introduces the sleep disorders screening checklist (SDS-CL), previously used for research. The SDS-CL meets both thoroughness and brevity criteria but has not yet been validated for primary care application. Psychometric properties of the SDS-CL are evaluated with data from a sample of n=694 adults representative of the primary care population. Psychometric properties of the SDS-CL are favorable for primary care application. The third manuscript is currently being prepared for submission to a journal focusing on primary or preventive care medicine. Finally, future studies are recommended.</p>