A landscape in crisis: A declining HIV workforce and increasing care demand

Background: Clinical providers report increasing caseloads as individuals with HIV live longer. The Affordable Care Act and programs under the National HIV/AIDS Strategy are expected to further increase caseloads as access to care increases. New providers offering HIV care are needed to ensure HIV-positive individuals continue to receive high quality care.

Methods: Data were gathered from the annual State of HIV Primary Care survey (1,806 respondents) that describes the workforce shortage. The national survey was conducted online with respondents recruited through targeted Invitations between July and October 2011. Both quantitative and qualitative data were collected. Data analysis focused on 445 prescribing clinicians or providers, who spend at least some of their time providing HIV primary care.

Results: Key results include from providers: • Two-thirds (66%) of reported an increased caseload over the past 12 months. • Providers focus as much on treating co-occurring conditions (50% heart disease, 49% renal disease, and 48% mental health) as they do treating HIV. • Forty-five percent cited the lack of clinical staff time to take on new roles and procedures as one of their top five barriers in providing HIV services.

Conclusion: While some providers express optimism about the changing HIV landscape, others express concern about patient caseloads increasing while reimbursements for treating HIV patients decrease. More HIV primary care providers are needed to address the growing need, while additional provider training is required to prepare them to treat HIV and implement new biomedical prevention technologies.