Why It Matters

In Iowa, the workforce that serves people living with HIV and works in prevention of HIV face challenges in recruitment, retention, and capacity building. The strength of this workforce directly impacts the health outcomes of people living with HIV and those vulnerable to HIV.

 

​These professionals include: PrEP/nPEP providers, Integrated Testing Services (ITS) personnel, medical providers and nurses, support services personnel, and public health staff.​

 

What We're Doing Now

Regional Health Specialist (RHS) Initiative
 

In 2016, IDPH developed an initiative that employed Regional Health Specialists (RHS) to provide clinical education to Iowa’s health and service provider workforce. Through a discipline called “academic detailing,” RHS provide evidence-based HIV, STI, and hepatitis education, especially to providers in rural parts of the state. When RHS deliver support and education to their stakeholders, those clinicians and service providers make better, evidence-based decisions, and those decisions improve the health of diverse populations throughout all of Iowa. Facilitated by the relationships developed between the RHS and the clinical/service provider workforce:
 

  • patients have improved access to culturally-responsive prevention services, including PrEP, condoms, and STI/HIV testing; and,
     

  • people living with HIV face reduced stigma when accessing primary care and other services in their rural communities

Capacity Building & Training
 

Integrated Testing Services (ITS) and Ryan White providers in Iowa receive training and ongoing capacity building from the Iowa Department of Public Health. IDPH staff regularly assess the training and capacity building needs of staff working at ITS and Ryan White-funded organizations.

Gaps, Barriers, & Challenges

Impacts of COVID-19
 

The COVID-19 pandemic has been very disruptive to the healthcare industry, the public health workforce, and those providing care to people living with HIV.

Before the COVID-19 pandemic, healthcare workers were already having difficulty keeping up with patient care. People are living longer and have more health care needs. Many healthcare providers are retiring, and there are not enough new people filling those jobs.

Many healthcare workers and public health staff have left the field and will not be returning. Those leaving cited burnout, mental health concerns, general health concerns, reduction in hours, loss of jobs, among other reasons.

In 2020, the ITS program saw decreases in the number of HIV and hepatitis C tests given due to the high demand for staff to respond to the COVID-19 pandemic (e.g. testing, vaccination, and contact tracing).

Recruitment

​Infectious Disease (ID) Providers and Providers Who Treat HIV

​The number of medical students entering infectious disease (ID) programs is now increasing for the first time in ten years.

 

However, there are still not enough ID physicians to meet the need for this speciality in the United States. Reasons for this include:

  • ID remains one of the lowest-paid speciality areas

  • It is very difficult to recruit physicians to Iowa

  • Many ID providers are non U.S.–born; therefore immigration policies are a concern.

  • Many residents feel that they do not have enough exposure to the ID field .

  • There are not enough scholarship/mentorship opportunities for the ID field.

 

Nursing

 

Prior to COVID-19, enrollment in nursing schools and nurse licensure were down in Iowa.  Despite increases in enrollment nationally, nursing shortages still exist. 

Nursing retention in Iowa is also challenging. Iowa is one of the lowest paying states for nurses. Many receive excellent training in Iowa, but leave for a better job opportunities.​

Retention

​Infectious Disease (ID), Providers Who Treat HIV, and Nursing

  • Retirement projections

    • Many ID physicians are over 55 (approaching retirement)

    • Nationally, 50.9% of the RN workforce is age 50 or older

    • Impending retirements in public health workforce, funding, salaries

  • COVID stress/burnout, stress that comes with the demands of the job

Integrated Testing Services 

  • Demands of outreach testing needs limits social lives, contributes to burnout, and impacts retention

  • Pay varies across agency types and can be low in CBO settings when compared to local public health settings

  • Often viewed as entry-level positions leading to advancement in other areas

Ryan White Case Management & Services

  • Lack of upward movement and growth opportunities: staff gain experience, then move on to another position that can offer a higher salary 

  • High caseloads

  • Schedules, workflow changes with COVID-19

Capacity Building
  • Gaining buy-in from private providers and health systems on the importance of sexual health histories, routine screening, and prescribing/managing PrEP. 
     

  • Developing and supporting the growth of infrastructure for nPEP access. 
     

  • Increasing awareness and acceptability of PrEP among cisgender women. 
     

  • Increasing awareness and acceptability of PrEP among men who have sex with men who don’t identify as gay or bisexual.

Where We Stand Today 

PrEP/nPEP providers
  • Iowa saw an increase of PrEP users by 22% from 2018-2019

  • In October 2021, the TelePrEP program received approval to formally include nPEP in the program’s service offerings

  • 89 unique PrEP providers agreed to be publicly listed on the Iowa PrEP directory 

 

Infectious Disease Providers and Providers who Treat HIV
  • 88% of the Infectious Disease fellowship positions were filled in 2020

  • 75% of Infectious Disease fellowship programs were filled in 2020

  • An assessment conducted in 2020 revealed 69 medical providers (physicians, nurse practitioners, and physician assistants) who provide HIV care to Iowa residents living with HIV.  This includes telemedicine clinicians and clinicians with multi-state licenses who may see Iowa residents living with HIV.

 

Nursing
  • Iowa Registered Nurse (RN) programs saw a 16% increase in enrollment in 2018 and an 18% increase in enrollment in Nurse Practitioner (NP) programs in 2018.

  • Nationally, officials with the American Association of Colleges of Nursing have said that applications are up 6 percent for the 2021 calendar year.

Case Management & Support Services
  • 12 Ryan White locations throughout the state provide case management and support services to PLWH.

  • Since 2016, IDPH has drastically increased the amount of funding available to contracted sites providing case management and support services. In 2016, RW funds contracted out by IDPH supported 38 FTE (full-time equivalent)  across the state to provide these services. In 2022 that increased to 69 FTE, an almost 82% increase. 

  • Retention among support services staff remains a concern.

Integrated Testing Sites (ITS)
  • 10 ITS sites throughout the state provide prevention services, including outreach, education, testing, and linkage to PrEP/nPEP. 

  • Since 2016, IDPH has increased the amount of funding available to contracted sites providing ITS services. In 2016, sites were able to support about .25 FTE (full-time equivalent) with IDPH funding. Since then, sites are able to support at-least 1 FTE, greatly increasing their capacity.

  • Partnership with the Iowa Pharmacy Association (IPA) to provide HIV/hepatitis C testing in community pharmacies.

Public Health Funding Increase
  • The Bureau of HIV, STD, and Hepatitis at the Iowa Department of Public Health has increased its workforce in recent years through the Capacity Extension Program (Contractors).

  • The Bureau of HIV, STD, and Hepatitis at the Iowa Department of Public Health has provided additional funding to local contractors across the state  to increase the workforce implementing HIV prevention and care programming. 

  • Midwest AIDS Training + Education Center (MATEC) has increased grant funding focused on workforce education/support within Iowa through special projects.

 
 
 

To stop HIV in Iowa by 2030, this focus area must:

  • Recruit and retain staff working in HIV prevention and care in Iowa.
     

  • Ensure staff working in the field of HIV have training and advancement opportunities.
     

  • Ensure staff working in the field are adequately compensated.
     

  • Ensure PLWH in Iowa have access to infectious disease specialists, primary care physicians, and others providing HIV medical care.
     

  • Decrease staff turnover and burnout.  

 

Process for Community Engagement 

Engagement Focus

This focus area will gather information about the current state of HIV care in Iowa. They will focus their efforts on the following questions:

Representation in health care
Does the workforce represent the people they serve?
Medical team
Do we have adequate staff working in the field of HIV prevention and care?
Meter of excellence
Are staff equipped with the knowledge & training to deliver the best care to PLWH and those vulnerable to HIV?
Handshake
What can be done to recruit new staff and retain staff in HIV prevention and care settings?
Putting together puzzle pieces
What is working and what best practices can be shared?

Gathering Feedback

Survey of approximately 70 providers (physicians, nurse practitioners, and physician assistants) who were identified in 2020 as providing HIV care to Iowa residents living with HIV.

Survey to Iowa providers and contractors, including all staff within the following settings:

  • Ryan White Part B & Part C

  • ITS

  • Local public health departments providing testing services

Primary Care Provider survey

  • Basic knowledge of HIV prevention, testing, and care

  • Stigma around HIV, U=U, etc.

Ryan White Part C Management survey

  • Support for onboarding