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

> **NIH NIH R34** · MASSACHUSETTS GENERAL HOSPITAL · 2024 · $168,824

## Abstract

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...

## Key facts

- **NIH application ID:** 10915044
- **Project number:** 5R34MH126753-03
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Christina Psaros
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $168,824
- **Award type:** 5
- **Project period:** 2022-09-09 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10915044

## Citation

> US National Institutes of Health, RePORTER application 10915044, Developing a resiliency intervention to support healthcare workers engaged in the provision of HIV care (5R34MH126753-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10915044. Licensed CC0.

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