Training and support needed to meet national Ending the HIV Epidemic goals, reports JANAC
The supply of healthcare professionals available to provide HIV care continues to decline, even as the need for HIV care and prevention is expected to increase, reports a survey study in the November/December issue of The Journal of the Association of Nurses in AIDS Care (JANAC). The official journal of the Association of Nurses in AIDS Care, JANAC is published in the Lippincott portfolio by Wolters Kluwer.
"Our study provides new insights into the numbers and characteristics of clinicians who will be available to provide HIV care in the coming years. This information will inform efforts to build the HIV workforce amid the ongoing shift from specialist care to primary care strategies," comments Andrea Norberg, DNP, MS, RN, and John Nelson,PhD, CPNP, FAAN, of the Rutgers School of Nursing François-Xavier Bagnoud Center, Newark, NJ.
Who will provide HIV care in coming years?
Current management of people living with HIV (PLWH) focuses on proactive use of effective antiretroviral therapy (ART) for HIV, as well as pre- and post-exposure prophylaxis (PrEP and PEP) to prevent HIV infection in people at risk. Using these strategies, the national Ending the HIV Epidemic in the US (EHE) targets a 90% reduction in new HIV infections by 2030.
The researchers designed a survey to provide an updated forecast of the US HIV clinician workforce over the next five years. The analysis included responses from a nationwide sample of 1,004 prescribing clinicians currently providing HIV-related healthcare. About 61% of respondents were physicians, 32% were advanced practice nurses or physician assistants, and eight percent were pharmacists.
The number of US clinicians available to provide HIV prevention and treatment is "substantially shrinking," the survey responses suggested. Overall, 10.5% of current clinicians reported that they would be leaving HIV care in the next five years while another 7.3% said they would be caring for fewer PLWH. Reasons for leaving or decreasing HIV care included retirement, administrative burdens, inadequate support, and burnout.
Workforce trends reflect shift to primary HIV care
Younger clinicians – especially under age 45 – were more likely to say they would maintain or increase their caseload of PLWH. Black respondents were more likely to say they would continue providing HIV care. Clinicians in some regions – including New York/New Jersey, Puerto Rico, and the US Virgin Islands – were more likely to say that that they would stop providing HIV care.
Nurse practitioners and family medicine physicians – who tended to be younger – were more likely to say they would continue providing HIV care. That finding reflects the ongoing shift toward HIV care "becoming more and more integrated into primary care practices," as opposed to infectious disease and other medical specialties.
"With expanding HIV prevalence and a 10.5% reduction in HIV clinicians over the next five years...the need for more HIV clinicians is paramount," the authors write. Estimates suggest that the number of people in need of HIV care will continue to increase in coming years, even if the EHE initiative meets its ambitious goals for reducing the incidence of new HIV infections.
The researchers discuss approaches to increasing preparation of primary care professionals – advance practice nurses, physician assistants, and family medicine and internal medicine physicians, among others – to meet the expected demand for HIV treatment and preventive care. Dr. Nelson and coauthors conclude: "More funding for HIV training of health professional students before licensure, as well as continued HIV education and support of clinicians post licensure are needed."
