Perceived Well-Being Is Associated with Frontline Workers' Capacity to Help Clients Access the HIV Continuum of Care

Background: The Centers for Disease Control and Prevention High-Impact HIV Prevention project aims to engage and retain high-risk individuals in the HIV Continuum of Care – HIV testing; primary care; Antiretroviral Treatment (ART); and support services like mental health and substance misuse. Individuals at risk are expected to access the first step of the continuum (i.e., HIV testing) assisted by social workers, health educators, and other frontline providers (“providers”).” Regrettably, at-risk individuals are not consistently linked to HIV testing and are not receiving needed care. This pilot study examines perceived “well-being” and providers’ capacity to help clients access the care continuum, namely by linking them to HIV testing. Results will form the basis of an intervention to improve well-being and HIV testing linkage-making.

Methods: Self-administered surveys (45-60 minutes) with 54 providers in 10 cities (15 agencies) in Michigan. We recruited community agencies and Health Departments supported by the Michigan Department of Health and Human Services, using a standardized script. “Well-being” was measured using the 7-item Scale Generalized Anxiety Disorder (GAD). Our main hypothesis was that providers with higher GAD levels would make fewer linkages to HIV testing in the prior six months. D We tested differences across GAD levels and provider income; job location (urban versus metropolitan); and familiarity with cultural/political developments in the area. Two-Sample T-tests were performed to test differences in mean GAD and variables of interest. Given the innovated nature of this study and small sample, p-values < 0.10 were considered as trending significance.

Results: Sample (n=54) included 34 females; 24 white participants, 23 African-Americans, five mixed-race, and one Asian-American. Half of providers reported mild to severe provisional diagnosis of GAD. Providers who linked <15 clients in the prior six months reported higher GAD than those linking >16 (p < 0.05). Higher GAD scores were associated with lower income (< $50K per year) (p < 0.05); urban location (p < 0.10); and low familiarity with current political developments (p < 0.05).

Conclusions: The small sample size and convenience sampling methodology limit generalizability of findings. However, these findings reveal the urgent need to address providers’ high GAD levels. GAD is associated with lower number of linkages to HIV testing, the first and most important step of the care continuum and may thus affect clients’ access to HIV testing – future research should focus on understanding why. GAD may also affect other areas of job performance, including referrals to other health and mental health services. Recommendations include; implementing interventions for providers which will specifically address GAD and also organizational and environmental interventions regarding income, location, and political developments affecting providers’ well-being.