Developing a resiliency intervention to support healthcare workers engaged in the provision of HIV care

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PROJECT SUMMARY South Africa (SA) has the largest HIV epidemic in the world, with 7.2 million people infected and a prevalence of 18.8% among adults ages 15-49. Nurses constitute the largest group of providers in SA’s healthcare system and are frontline treaters in HIV care. They experience particularly high levels of burnout resulting from resource limitations, chronic work overload, and occupational stress; inadequate staffing, resources, and wages; increased task-shifting work to nurses; interpersonal conflict; and HIV stigma, including stigma by association. These stressors are worsened in the context of the COVID-19 pandemic. Provider stress and burnout leads to negative patient outcomes for persons living with HIV (PLWH), including: (1) self-reported suboptimal care and attitudes toward patients; (2) decreased patient satisfaction; (3) increased post- hospitalization recovery time; and (4) reduced adherence to highly active antiretroviral therapy (HAART) and HIV testing uptake as a result of experienced or anticipated negative patient-provider interactions. Patient- provider relationships are a core element of engagement and retention in HIV care; patients prefer providers who have good communication skills, and are empathetic, engaging, and validating, behaviors that are difficult to emulate in the context of high stress and burnout. Interventions that foster resilience can minimize the negative impact of work-related stress; however, despite decades of research into individual, patient-level factors impacting HIV care engagement, no known interventions have systematically attempted to support the wellbeing of nurses in SA by providing them with skills to more effectively manage and cope with stressors that negatively and directly impact patient outcomes. The objective of this application is to adapt the Relaxation Response Resiliency Program (3RP) to the needs of nurses providing HIV care in the public sector in SA to build resilience and reduce stress, and ultimately improve patient-related outcomes. We propose the following specific aims as part of this formative feasibility and acceptability study: (1) to explore the ways in which the 3RP requires adaptation to meet the needs of nurses providing HIV care in the public sector in SA, based on data collected from qualitative focus group discussions, and to adapt the intervention accordingly, and (2) after a small proof-of-concept study, to conduct a randomized pilot of nurses providing HIV care in the public sector in SA to test the feasibility and acceptability of all study procedures. The proposed work will contribute to our understanding of how to offset high stress and burnout among HIV care nurses in SA’s public sector, a setting with the world’s most significant HIV burden, where nurses are the frontline treaters. These data will inform a larger, multi-site, randomized efficacy trial looking at the impact of the intervention on the wellbeing of nurses, as well as on patient outcomes (e.g., successful engagement in HIV care, patient-nurse trust, satisfaction with care, and viral suppression) in public health sector clinics nationwide. Ultimately, we hope to develop an intervention with applicability to other providers in other resource-limited settings.