Support needs of paediatric HIV care workers in 12 African countries

Abstract

Frontline healthcare workers providing HIV services to children, adolescents and their families in Africa face significant stressors and well-being related challenges. These in turn may also impact their ability to provide high-quality, compassionate care. Despite healthcare providers’ central role in the delivery of care and support for others, there is limited research exploring their well-being and self-care. This study examined the well-being and self-care-related challenges and needs among healthcare workers providing HIV services to children, adolescents and their caregivers in Africa. A qualitative study design was employed, including participatory priority-setting and focus group discussions with 801 providers across 24 sites in 12 high HIV-prevalence African countries. Data were thematically analysed and Orem’s Theory of Self-Care and the Self-Care Matrix were employed to guide the interpretation and organization of findings. The study identified four major themes. First, participants described burnout and personal struggles as well-being related challenges. Second, they described the belief that addressing these challenges was important for their own well-being, as well as the well-being of their patients. Third, awareness of healthcare worker well-being, alongside effective communication are important contributors to a healthier workforce. Lastly, several interventions were suggested, including fostering teamwork, providing education, and offering psychosocial support within the workplace. Findings emphasize the critical need for tailored interventions that can inform future practices and strategies for healthcare worker well-being. Ultimately, these interventions are crucial for better supporting healthcare providers, enhancing their well-being, and addressing the ongoing challenges in HIV care to children and adolescents in Africa.

Introduction

Frontline healthcare providers face unique well-being challenges, including workplace exhaustion and high job demands [1]. For these providers to effectively meet patient needs, it has been suggested that they prioritize self-care and maintain their well-being [2]. Because healthcare providers’ work environments impact their mental and emotional well-being, providing targeted support for these needs is critical to sustaining their capacity to deliver compassionate, high-quality care [3].

It has been suggested that healthcare workers providing HIV services to children, adolescent and their families in Africa face well-being challenges due to high-stress environments and the lack of supportive resources in place [4]. In 2020, approximately 1.7 million children under 15 years were living with HIV globally; the majority of whom reside in sub-Saharan Africa [5]. Furthermore, some countries in Southern Africa have rates greater than 100 per 100,000 deaths from HIV/AIDS, and these outcomes are worse for children [6]. A sustained focus on the well-being of frontline providers may enable more resilient health systems in Africa [7] and a more effective, sustainable and holistic response to the paediatric-adolescent HIV epidemic.

Historically, the well-being of frontline health providers has received little attention, though the COVID-19 pandemic brought more awareness to this issue [8]. Global evidence in response to the COVID-19 pandemic presents a further impetus for this work: a 2022 study conducted in Minnesota found that 70% of frontline healthcare workers experienced moderate or moderately severe depression, and 99.2% reported high levels of stress [9]. Furthermore, in Medscape’s 2021 National Physician Burnout and Suicide Report, 42% of physicians reported burnout, and 47% reported a severe impact of their jobs on their personal lives [10]. These numbers indicate a rise in the need for mental health and well-being support and self-care amongst frontline providers. A pronounced effect of COVID-19 was the tremendous impact on the psychosocial well-being of frontline health providers, including those in the paediatric-adolescent HIV response [11]. Furthermore, the pandemic has placed an additional burden and strain on both health systems and healthcare workers themselves [11]. Challenges reported among nurses in South Africa include adequate training, infrastructure, the availability of personal protective equipment, and management support for managing stress and anxiety [12]. Therefore, the pandemic underscored a critical need to prioritise mental well‑being and self‑care within healthcare facilities.