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

项目摘要 南非（SA）是世界上艾滋病毒流行最多的国家，有720万人感染， 在15-49岁的成年人中占18.8%。护士构成了SA医疗保健系统中最大的供应商群体 他们是艾滋病护理的一线工作人员。他们经历了特别高水平的倦怠， 资源限制、长期超负荷工作和职业压力;人员配备、资源和 工资;增加护士的任务转移工作;人际冲突;以及艾滋病毒污名化，包括 协会在COVID-19大流行的背景下，这些压力因素更加恶化。供应商压力和 倦怠导致艾滋病毒感染者（PLWH）的负面患者结果，包括：（1）自我报告 次优护理和对患者的态度;（2）患者满意度下降;（3）术后 住院恢复时间;（4）减少对高效抗逆转录病毒治疗（HAART）的依从性， 由于经历或预期的负面患者-提供者互动而进行艾滋病毒检测。病人- 提供者关系是参与和保留艾滋病毒护理的核心要素;患者更喜欢提供者 具有良好的沟通技巧，具有同理心、参与感和认同感，但行为却很困难 在高压力和倦怠的情况下模仿。促进复原力的干预措施可以最大限度地减少 工作压力的负面影响;然而，尽管几十年来对个人，患者水平的研究 影响艾滋病毒护理参与的因素，没有已知的干预措施系统地试图支持 通过为他们提供技能，更有效地管理和科普压力源， 负面且直接影响患者结果。此应用程序的目的是适应松弛 响应弹性计划（3RP），以满足南非公共部门提供艾滋病毒护理的护士的需求， 建立弹性和减少压力，并最终改善患者相关的结果。我们提议下列 作为这一初步可行性和可接受性研究的一部分， 3RP要求进行调整，以满足在南非公共部门提供艾滋病毒护理的护士的需求， 从定性焦点小组讨论中收集的数据，并相应地调整干预措施，以及（2）在 一项小型概念验证研究，对在公共部门提供艾滋病毒护理的护士进行随机试点 在SA中测试所有研究程序的可行性和可接受性。拟议的工作将有助于我们 了解如何抵消高压力和倦怠之间的艾滋病毒护理护士在SA的公共部门，一个设置 艾滋病负担最重的国家，护士是第一线的艾滋病预防者。这些数据将通知A 一项大型、多中心、随机疗效试验，旨在观察干预措施对护士健康的影响， 以及患者结果（例如，成功参与艾滋病护理，病人-护士信任， 护理和病毒抑制）。最终，我们希望开发一个 在其他资源有限的情况下，干预措施也适用于其他提供者。

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.