Examining HIV Training Pathways in Residency

April 10, 2020

HIV training pathways in residency have added 90 HIV physicians to the workforce since 2006.

HIV training pathways in residency could help increase the number of health care practitioners who care for people with HIV, stepping up the fight against the disease, a new study confirmed.

The Ending the HIV Epidemic initiative calls for a 90% decrease in the annual incidence of HIV infections during the next decade, putting higher demand on the medical work force to provide the diagnosis, antiretroviral treatment, preexposure prophylaxis (PrEP), and other services needed to meet that goal.

The study, published in Clinical Infectious Diseases, identified 25 residency programs in the United States with dedicated HIV programs, from which 228 residents have graduated since 2006, 90 of which (39%) provide primary care to people with HIV.

“Training more clinicians to care for PWH [people with HIV] is critical to generate and sustain a proficient HIV provider workforce to deliver high-quality, culturally sensitive care,” the study authors noted.

The need for a new pipeline of HIV health care workers is compounded by workforce shortages brought on by retirements, limitations in training, and low reimbursement.

The study identified HIV pathways within family medicine and internal medicine residencies in the United States and sent a 33-item, quantitative survey to 25 HIV pathway directors with questions about pathway curricula and implementation, graduate outcomes, and challenges. The goal of most programs (64%) was to prepare students to practice HIV medicine, while the goal of 28% was to expose generalists to HIV medicine.

HIV pathways have graduated a total of 228 residents since 2006, including 77 from family medicine residencies and 151 from internal medicine residencies. A total of 105 (46%) earned American Academy of HIV Medicine certification, and 90 (39%) provide primary care to more than 20 people with HIV.

Most pathways were located in the West and Northeast regions of the United States, and most graduates remained in and provide HIV care in those areas. The Ending the HIV Epidemic initiative focuses on geographic areas, predominantly in the South, which account for 50% of new HIV infections.

“[I]n order to make a broader impact on the HIV workforce, more HIV pathways are needed, and this expansion must be combined with novel strategies to match these providers with patients in geographic areas of need,” the study authors wrote, recommending that national efforts to expand HIV pathways should emphasize development in the South.

Care for patients with HIV has moved from specialist to primary care practices as the disease has become more manageable. At the 2019 Association of Nurses in AIDS Care Conference, a poster presentation examined how nurse practitioners can assume a larger role in HIV care and looked at the implementation of the National HIV Curriculum into nursing education at the University of San Francisco School of Nursing.

Other efforts to boost accessibility to HIV care have included a proposal to allow nurses to dispense PrEP. That approach, referred to as “Pre-Exposure Prophylaxis-Registered Nurse (PrEP-RN),” uses existing workforce to deliver PrEP in sexually transmitted infection and HIV testing clinics.

The recent study recommended that existing HIV training pathways establish best practices and enhanced communication along with a focus on career development to improve pipelines to employment in HIV care.

“Expanding and empowering the HIV provider workforce is a critical component of the Ending the HIV Epidemic initiative,” the authors concluded.