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Strengthening Nursing Research Capacity to End the HIV Epidemic: Qualitative Insights of the Mid-Atlantic Center for AIDS Research Nursing Initiative Symposium

Year: 2025

Type: article

Abstract: Globally, clinical nurses manage most of the daily care and treatment as well as address persistent health inequities among people living with HIV (Sprague, 2024). However, nursing contributions to HIV scientific innovation are sometimes overlooked—most notably as independent investigators, experts, and thought leaders. This occurs amid a crisis in the nursing workforce in which less than 1% of nurses are PhD-prepared and trained to lead scientific research (Cashion, 2019; Smiley et al., 2021). The National Institutes of Health (NIH)-funded Center for AIDS Research (CFAR) program provides an excellent opportunity to stimulate research led by nurses through training and leadership and thus integrating unique perspectives into HIV research across geographic regions (CFAR National Institute of Allergy and Infectious Diseases, n.d.). Development and support of a high-functioning and sustainable nurse scientist workforce is imperative to adequately address HIV across the continuum of prevention and treatment. For example, in the Mid-Atlantic region of the United States, HIV affects populations facing structural vulnerabilities in numbers disproportionate to their representation in the general population. In 2023, Black and African American people represented 44.9% in PA (Bureau of Epidemiology & Pennsylvania Department of Health, 2023; District of Columbia Department of Health, 2023) and 65.0% in MD (Maryland Department of Health, 2024) of new HIV infections, despite accounting for only 12.3% (PA) and 31.6% (MD) of the states' populations (U.S. Census Bureau, 2024a, 2024b). High infection rates are especially pronounced among young people, individuals living in urban neighborhoods with high concentrations of poverty, and among racially marginalized people in discrete social networks (e.g., Washington, DC; Baltimore City, MD; Philadelphia, PA; Centers for Disease Control and Prevention, 2024). These characteristics provide a foundation for understanding the drivers of structural vulnerabilities that enhance risks for HIV transmission among populations that nurse-led HIV scientific discoveries are uniquely suited to address. As the HIV epidemic continues to evolve, opportunities to leverage existing nursing clinical and research expertise have become more crucial. Benefiting from these opportunities requires intentionally developing HIV-related content expertise and research leadership to move the ambitious goals for Ending the HIV Epidemic forward (Centers for Disease Control and Prevention, 2024). Nurses represent the largest health care workforce globally (Wakefield et al., 2021). They have been leaders in generating and advancing the translation of science to practice in health and well-being among communities most affected by the HIV pandemic for more than 40 years (Swanson et al., 2021). Nurse-trained clinicians, leaders, and scientists have been at the forefront of political and social movements toward preventive care across tertiary, secondary, and primary care settings (Wakefield et al., 2021). Nurses are poised to strengthen the scientific rationale for developing innovative HIV interventions guided by practical clinical experiences and grounded in health equity and implementation science. For decades, nurses and nurse-scientists have profoundly contributed to generating evidence on sexual and reproductive health promotion (Santa Maria et al., 2017), HIV medication adherence (Lambert et al., 2021), and aging processes across multiple chronic conditions, including HIV (Ghamgosar et al., 2021; Vance et al., 2019). For example, in the US Mid-Atlantic region, most people living with HIV (54.3%) are ages 50 years or older, and as of 2023, new diagnoses among those age groups continued to climb (Bureau of Epidemiology & Pennsylvania Department of Health, 2023; District of Columbia Department of Health, 2023; Maryland Department of Health, 2024). Older adults living with HIV may require special care considerations because they navigate multiple chronic conditions, and nurses and nurse-scientists are uniquely suited to examine these issues, providing appropriate evidence-based solutions. This is just one example of an opportunity for nurses and nurse-scientists to bring together existing expertise from nursing science to strengthen the HIV research agenda with a strategic focus. In this article, we describe a nurse-led initiative, the Mid-Atlantic Center for AIDS Research Consortium (MACC) Nursing Initiative, designed to increase the number of nurse-scientists focused on HIV research and enhance training and mentoring for early-career nurse-scientists. We then describe the activities and outcomes of the Inaugural CFAR MACC Nursing Initiative Symposium. The article concludes with a call to action and priority recommendations that nurses and nurse-scientists can use as a roadmap for future nurse-led HIV research. The Mid-Atlantic Center for AIDS Research Consortium Nursing Initiative The MACC comprises the Johns Hopkins University, the DC CFAR (a longstanding partnership of nine institutions including American, Georgetown, Howard, and George Washington Universities, the DC Veterans Administration, The DC Department of Health, Children's National Medical Center, and two community-based organizations, Whitman-Walker Institute and Us Helping Us), and University of Pennsylvania Centers for AIDS Research. The MACC was formed in May 2014 in response to a concern about the HIV epidemic shared by the Baltimore, Philadelphia, and Washington, DC, geographical regions. The consortium works on publications and joint funding applications, providing grant funding and mentorship to early-stage investigators. It also offers mentorship and development opportunities through didactic training, applied learning activities, and intensive implementation science coaching (Greenberg et al., 2022). In 2017, the MACC developed a Scholars Program designed for scholars underrepresented in HIV research who are interested in studying the HIV epidemic in the region (Brown et al., 2019; Limaye et al., 2019). The goal of the MACC Scholars Program is to support the development of early-stage investigators with research interests in HIV in the Mid-Atlantic region and foster their development as HIV prevention and/or treatment investigators. In 2021, MACC CFAR leadership identified a need to develop the capacity of nurse-scientists with expertise in HIV research within our region. The resulting MACC Nursing Initiative is a multidisciplinary, collaborative group of equity-focused HIV scientists from MACC-affiliated Schools of Nursing. MACC Nursing Initiative activities have since included (a) an in-person inaugural meeting and workshop titled “Developing Winning HIV Research Grants,” held in Washington, DC, during the 2021 Association for Nurses in AIDS Care Annual Conference; (b) two virtual meetings showcasing research by student and faculty scientists, hosted by the University of Pennsylvania and Johns Hopkins University CFARs; (c) virtual meetings to share information about HIV-related funding and training opportunities; and (d) monthly planning meetings among the leadership team. The meetings are open to all nursing faculty and doctoral students interested in HIV. Guest speakers have included HIV nurse-scientists from the National Institutes of Nursing Research (NINR), current NIH HIV study section members, and national CFAR leaders. After these initial activities in 2021 and 2022, the MACC Nursing Initiative leadership enumerated several challenges to achieving the Initiative's goals: (a) fewer students with interests in HIV research are entering research doctoral programs in nursing schools, (b) there are few faculty currently conducting HIV research at each of the member nursing schools, and (c) the systems for implementing collaborative scientific projects with regional partner academic institutions outside the CFAR MACC cause significant delays in mounting new research endeavors. These challenges could prevent the Initiative's crucial objectives from moving forward with maximal efficacy. For example, we did not want to offer competitive funding and training for nurse-led HIV-focused projects without bolstering systems in nursing schools to generate scientific interest in HIV among students and faculty. However, leaders from the MACC-affiliated CFARs continue to include prominent HIV scientists, deans, and other administrative leaders who are investing in the goals of the MACC Nursing Initiative. The MACC Nursing Initiative aims to address identified challenges and build on the success of the MACC Scholars Program, which demonstrates success in developing early-career HIV investigators (Greenberg et al., 2022; Limaye et al., 2019). Leveraging this existing infrastructure provides opportunities for sustainability and is specifically designed for early-career nurses and investigators who need to create interdisciplinary networks for developing cutting-edge HIV research. National Institutes of Nursing Research Strategic Plan, Emerging Priorities, and Guiding Principles As the lead funding agency for nursing research within the National Institutes of Health, the NINR supports emerging nurse-investigators through training (https://www.ninr.nih.gov/). It advances the nation's nursing research footprint, and between 2014 and 2023, it has awarded more than 2,700 grants totaling more than 1.25 billion dollars to scientists, many of them nurse-scientists (NIH Awards by Location and Organization—NIH Research Portfolio Online Reporting Tools [RePORT], n.d.). The NINR's commitment to diversifying the nurse-scientist workforce and advancing research that bridges clinical care with community resources aligns with the vision of the CFAR MACC Nursing Initiative. In their Strategic Plan 2022–2026, leaders at NINR describe five research lenses applicable to nurse-led HIV investigations: (a) health equity, (b) social determinants of health (SDOH), (c) population and community health, (d) prevention and health promotion, and (e) systems and models of care (National Institute of Nursing Research, n.d.). We selected two of these domains, SDOH and prevention and health promotion, to guide the structure of our CFAR MACC Nursing Initiative Symposium. The primary goal of the SDOH lens is to identify effective approaches to improve health and quality of life by addressing the conditions in which people are born, live, learn, work, play, and age. Likewise, the Prevention and Health Promotion lens focuses on disease prevention and health promotion through the continuum of prevention, from primordial to tertiary prevention (NINR, n.d.). The Symposium Purpose The purpose of the inaugural CFAR MACC Nursing Initiative symposium, held in May 2024, was to strengthen inter-CFAR nursing networks and collaboration, facilitate nursing knowledge sharing, and foster nurse-led community-engaged HIV research to reduce inequities in HIV prevention and treatment outcomes. The symposium's on networks and represented a toward the MACC Nursing Initiative's goal of providing and collaborative resources for nurse-led HIV scientific research projects across the Mid-Atlantic region. 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Nurses are not only of care are among the most health resources among success requires that the communities most affected by HIV and that prevention and response are evidence and of with unique for strategic nursing and nursing science can the that and scientific leaders in the Ending the HIV Epidemic in the United The from at the MACC Nursing Initiative are with the and lenses by evidence and care at high these from existing and scientific to Center for AIDS Research Mid-Atlantic Center for AIDS Research Consortium Nursing Initiative National Institutes Institutes of Nursing Research Research and National from the Symposium National NINR NINR the of nursing and nursing science on the HIV that address the HIV epidemic among all and and the and structural inequities that at an and in their health and community health and models of care the of nurse-led and evidence-based practice support HIV-related health outcomes of people with HIV-related and health inequities effective approaches to improve health and quality of life by addressing the conditions in which people are born, live, learn, work, play, and age Health and models of care support for HIV Care outcomes new HIV health challenges at the that groups of people with shared characteristics Prevention and health promotion and models of care SDOH social determinants of health In a information we a to leaders at all CFARs to the need for an interest in developing an Nursing Research We across the CFARs in the United represented CFARs from region in the United a current with a nursing for from nurses and representation by within their CFAR on their or in other several to with a nursing most that they interested in in an Nursing Research and that they need to it within their The MACC Scholars Program and MACC Nursing Initiative offer models for other inter-CFAR to to support the of scientists, including nurse-scientists. and from the partner CFARs to support at one early-career nurse-scientist is a to innovative interdisciplinary can in the Mid-Atlantic region. Leveraging these existing within the of the National CFAR we offer the recommendations to that scientific discoveries a maximal response to the HIV nurse-led scientific approaches to the HIV This and with nursing goals investing in with and and other to that prevention and response are to the and of people living with or affected by HIV. nursing and other health leaders to in and training This infrastructure on scientific focused on addressing HIV-related health a nurse-led scientific vision for HIV and including implementation outcomes. This include and that all HIV prevention and response activities are community and This on the of nurses as for health and and our unique of in community-based during the CFAR MACC Nursing Initiative's symposium, the of Nursing Research to the the need for nurse-led scientific approaches with for success and implementation science to the HIV prevention and response continue to toward the HIV This provides a for nurse-scientists in HIV research that can support research in the Mid-Atlantic region and The or interests to this article that could as a of may through a to the on this the for as identified by the of Medical all have contributed to the and of the or have been in this the of this and to for all of the the the contributions of each are as and nurse-led research and practice to address the HIV epidemic across the continuum of care is imperative to reduce HIV-related health a nurse-scientist workforce with training, and resources to we need on and training approaches that are of nurses currently in (National Institute of Nursing to address health inequities are with a nurse-led HIV research agenda that community innovative to reduce and systems approaches that can across settings nurses are uniquely to

Source: Journal of the Association of Nurses in AIDS Care

DOI: 10.1097/jnc.0000000000000593