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Principal Investigator: Christina Psaros
Organization: MASSACHUSETTS GENERAL HOSPITAL
Fiscal Year: 2024
Award: $168,824
Funding agency: National Institute of Mental Health
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.
Terms: <21+ years old><AIDS Virus><AIDS test><AIDS/HIV test><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Address><Adherence><Adult><Adult Human><Affect><Age><American><Attitude><B.1.351><Behavior><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Care given by nurses><Caring><Chronic><Client satisfaction><Clinic><Communication><Coping Skills><Data><Discipline of Nursing><Educational process of instructing><Elements><Eligibility><Eligibility Determination><Empathy><Enrollment><Epidemic><Evaluation><Feedback><Focus Groups><Fostering><Goals><HAART><HIV><HIV test><HIV-1 test><HIV-2 test><Health><Health Care Providers><Health Care Systems><Health Personnel><Healthcare Providers><Healthcare Systems><Healthcare worker><Highly Active Antiretroviral Therapy><Home><Hospital Admission><Hospitalization><Human Immunodeficiency Viruses><Human immunodeficiency virus test><Hybrids><Immunity><Individual><Intervention><Intervention Strategies><Interview><Jobs><LAV-HTLV-III><Length><Low-resource area><Low-resource community><Low-resource environment><Low-resource region><Low-resource setting><Lymphadenopathy-Associated Virus><Measures><Medical><Nurses><Nursing><Nursing Care><Nursing Field><Nursing Profession><Occupational><Occupations><Outcome><Participant><Patient Satisfaction><Patient Self-Report><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Perception><Personal Satisfaction><Persons><Prevalence><Prevention><Procedures><Professional Positions><Protocol><Protocol Screening><Protocols documentation><Provider><Province><Psychology><Public Health><Public Sector><Randomized><Recovery><Relaxation><Research><Research Resources><Resource-constrained area><Resource-constrained community><Resource-constrained environment><Resource-constrained region><Resource-constrained setting><Resource-limited area><Resource-limited community><Resource-limited environment><Resource-limited region><Resource-limited setting><Resource-poor area><Resource-poor community><Resource-poor environment><Resource-poor region><Resource-poor setting><Resources><SARS-CoV-2 B.1.351><SARS-CoV-2 beta><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Salaries><Self-Report><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Shoulder><Site><Source><South Africa><South Africa strain><South Africa variant><South African strain><South African variant><Stress><Teaching><Time><Trauma><Trust><Vertical Disease Transmission><Viral><Viral Burden><Viral Load><Viral Load result><Virus-HIV><Wages><Work><World Health><acceptability and feasibility><adulthood><ages><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><build resilience><build resiliency><burn-out><burnout><clinical relevance><clinically relevant><coping><coping strategy><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><day shift><develop resilience><develop resiliency><develop therapy><efficacy trial><enhance resilience><enhance resiliency><enroll><experience><feasibility testing><health care personnel><health care worker><health provider><health workforce><healthcare personnel><homes><improve resilience><improve resiliency><improved><increase resilience><increase resiliency><interpersonal conflict><intervention development><interventional strategy><medical personnel><member><migration><mother to child transmission><night shift><night work><nurse><obstacle to care><obstacle to healthcare><occupational stress><patient barriers><patient oriented outcomes><patient-level barriers><premature><prematurity><programs><promote resilience><promote resiliency><randomisation><randomization><randomly assigned><resilience><resilience development><resilient><resilient to stress><response><satisfaction><severe acute respiratory syndrome coronavirus 2 B.1.351><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><shift work><shiftwork><skills><social stigma><stigma><stress buffering><stress management><stress reduction><stress resilience><stress resiliency><stressor><testing uptake><therapy development><treatment development><treatment provider><virtual><well-being><wellbeing>