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

项目总结 南非(SA)的艾滋病毒疫情是世界上最大的，有720万人感染，流行率为 在15-49岁的成年人中占18.8%。护士构成了南澳医疗系统中最大的提供者群体 是艾滋病护理的一线治疗人员。他们经历了特别高水平的职业倦怠，原因是 资源限制、长期工作超负荷和职业压力；人员配备、资源和资源不足 工资；更多地将任务转移给护士；人际冲突；艾滋病毒污名，包括 协会。在新冠肺炎大流行的背景下，这些压力源更加严重。提供商压力和 职业倦怠导致艾滋病毒携带者(PLWH)的负面患者结局，包括：(1)自我报告 对病人的护理和态度不佳；(2)病人满意度下降；(3)术后增加 住院恢复时间；以及(4)减少了对高效抗逆转录病毒疗法(HAART)的坚持和 患者与提供者之间有经验的或预期的负面互动导致的HIV检测吸收。病人- 提供者关系是HIV护理中参与度和保留率的核心要素；患者更喜欢提供者 他们有良好的沟通技巧，并具有同理心、吸引力和认同感，这些行为令人难以接受 在高压力和精疲力竭的情况下效仿。培养韧性的干预措施可以最大限度地减少 工作相关压力的负面影响；然而，尽管数十年来对个人、患者层面的研究 影响艾滋病毒护理参与度的因素，但尚无已知的干预措施系统地尝试支持 通过向南澳护士提供更有效地管理和应对压力源的技能，提高他们的幸福感 对患者的预后产生负面和直接的影响。这个应用程序的目标是适应松弛 应对南非公共部门提供艾滋病毒护理的护士的需求的应变计划(3RP) 增强复原力，减轻压力，最终改善与患者相关的结果。我们提出以下建议 作为这项形成可行性和可接受性研究的一部分的具体目标：(1)探索 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的 了解如何消除南非公共部门艾滋病毒护理护士的高度压力和职业倦怠 有世界上最严重的艾滋病毒负担，那里的护士是第一线的治疗者。这些数据将向 更大规模的多点随机疗效试验，旨在观察干预对护士福祉的影响， 以及患者结果(例如，成功参与艾滋病毒护理、患者与护士之间的信任、对 保健和病毒抑制)在全国的公共卫生部门诊所。最终，我们希望开发一种 在其他资源有限的情况下适用于其他提供者的干预。

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.