HIV Workforce Lacks Science & Treatment Knowledge to End HIV/AIDS Epidemic

Doing better

This Friday, the Black AIDS Institute will publish a report contextualizing the results of a study showing that not only do many non-medical members of the HIV/AIDS workforce lack knowledge of basic HIV science and terminology, they do not understand the science of HIV treatment or the recent biomedical interventions needed to end the AIDS epidemic.

"When We Know Better, We Do Better: The State of HIV/AIDS Science and Treatment Literacy in the HIV/AIDS Workforce," presents results from the U.S. HIV Workforce Knowledge, Attitudes, and Beliefs (KAB) Survey, the largest survey ever conducted of non-medical personnel working in HIV/AIDS in the United States. (The link goes live on Friday, February 6, 2015 at 12:01 a.m.) On Friday, the Institute will launch the #KnowBetterDoBetter Tour, a series of town hall meetings to help the public and media understand survey results for 10 major American cities.

Overall, HIV/AIDS health care service providers at health departments and AIDS-service and community based organizations answered only 63 percent of questions correctly—essentially earning a D grade in their knowledge of HIV science and treatment.
Participants were more likely to answer questions about basic science correctly, scoring a 76, or a C. But the average score on treatment-related questions was a 56, or an F.

Respondents appear particularly ill-prepared to assist HIV-negative people in using antiretroviral-based biomedical prevention tools, such as pre-exposure prophylaxis (PrEP), or to help HIV-positive people in understanding treatment as prevention—tools essential to ending the HIV/AIDS epidemic. Participants answered 46 percent of biomedical questions accurately, an F.
Given the goal of achieving an AIDS-free generation, participants' lack of knowledge is shocking.

"All the tools in the world will not end HIV/AIDS unless those responsible
for using these tools understand them, believe in them, and know how to use them," says Phill Wilson, President and CEO of the Black AIDS Institute.

HIV/AIDS Workforce Demonstrates Low HIV Science and Treatment Literacy

Conducted by the Black AIDS Institute in partnership with the Centers for Disease Control (CDC), the Latino Commission on AIDS, the National Association of State and Territorial AIDS Directors (NASTAD), Johns Hopkins University and Janssen Therapeutics, Division of Janssen Products, L.P., the KAB study surveyed more than 3600 workforce participants from 48 states, Washington, D.C., and the U.S. Territories, including case managers, social workers, prevention educators, testers and counselors, public health workers and advocates, policy makers, contractors and volunteers. Fifty-four percent of respondents were men; 57 percent were people of color; 16 percent reported living with HIV/AIDS. The survey had a margin of error of plus or minus two points.

Overall, seventy percent of survey participants answered so few questions correctly that they scored a D; only 4 percent earned an A. More than one-third of respondents got less than 60 percent of the answers right. Most HIV workers do understand some basic facts about HIV—how it 
is transmitted, how it is diagnosed, and that treatments are available, for instance—but only well enough to earn a C.

Nearly two decades have passed since
the introduction of Highly Active Antiretroviral Therapy,
yet the HIV/AIDS workforce still lacks knowledge about the basics of HIV treatment, scoring an F on treatment-related questions—causes of drug resistance, the relationship between adherence and drug resistance, and the typical trajectory of CD4 and viral load when an individual's HIV infection is left untreated, for example.

And more than two years after the Food and Drug Administration approved PrEP, participants reported feeling that they had insufficient knowledge of biomedical interventions to advocate for either PrEP or treatment as prevention. Respondents also indicated that they were skeptical about biomedical interventions.

"To ensure rapid and effective use of these biomedical tools, the HIV/AIDS workforce needs to possess strong understanding of HIV science and treatment and a passionate belief in the effectiveness of the HIV/AIDS toolkit," says Wilson.

Mark Harrington, executive director of the Treatment Action Group, wonders whether results on PrEP-related questions might have been somewhat higher were the survey administered in 2015 rather than in 2012-2013. With a robust national debate playing out on the safety and efficacy of PrEP in 2014—and with the CDC issuing formal guidance endorsing PrEP in the midst of this debate—Harrington views
last year as an inflection point in the AIDS field's understanding of this biomedical intervention.

"A whole lot of changes happened in 2014 that may have made the answers to these questions a lot different," Harrington says.

Disparities in HIV Science And Treatment Knowledge Exist among HIV/AIDS Workers

Even though HIV/AIDS is disproportionately concentrated in communities of color, Black and Latino respondents scored about six points lower than White survey participants. This was true even after controlling for education, region, time working in the AIDS field, or any other variable.

LGBT and HIV-positive workers scored about three points higher than the workforce as a whole. Study participants working in smaller organizations were less likely to exhibit strong HIV science and treatment knowledge than those in larger organizations. Those working at community-based organizations demonstrated generally lower scores than staff at AIDS service organizations. There appeared to be no major difference in worker literacy on HIV science and treatment issues between state and local health departments and those working at AIDS service organizations.

Among all variables studied, the participant's educational attainment was most closely correlated with higher scores on the survey. The longer a worker remained in the AIDS field, the higher on average was his or her knowledge level, with especially pronounced knowledge advantages among people who had worked at least 10 years in HIV/AIDS.

Respondents from the Deep South scored two points lower, on average, than workers from other regions—a distinction that persisted even after controlling for educational level and other variables.

"Access to training may be the key factor that explains these differences," says said Leisha McKinley-Beach, HIV program administrator for the Fulton County Department of Health and Wellness. "Many Southern organizations and health departments are focused on reaching deliverables and indicators required by funders and may not be prioritizing training."

Training to Reach an AIDS-free Generation

To help ensure that the HIV/AID workforce is prepared to help end the AIDS epidemic, the report recommends that the United States undertake an urgent effort to increase science and treatment knowledge among the HIV/AIDS workforce, make sure that opportunities for continuing education exist, develop a certification system, establish a set of core competencies and increase the percentage of PLWHA who are in the workforce.

"It is clear that the HIV workforce has decades of useful experience," says Harrington. "But now we need to ensure that medical training is part of their skill set."

"We have a lot of work to do to close the HIV/AIDS knowledge gap. But the dividends that this knowledge can pay should inspire us," says Wilson. "We really can be the generation that ends the HIV/AIDS epidemic. Let's now get busy ensuring that our HIV/ AIDS workforce is prepared to lead that fight."


Adapted from the Black AIDS Institute Report, "When We Know Better, We Do Better: The State of HIV/AIDS Science and Treatment Literacy in the HIV Workforce," published on February 5, 2015.