# Providers’ Perspectives on the Social Determinants of Health and Burnout Among HIV Care Providers in the United States

## TL;DR

This study explores how social factors and provider burnout affect HIV care in the U.S., highlighting barriers like financial instability and lack of resources.

## Contribution

The study provides new insights into how social determinants and burnout specifically impact HIV care providers across different U.S. regions.

## Key findings

- 62% of providers reported feeling burned out, with emotional exhaustion being a significant factor.
- Financial instability and transportation problems were the most commonly reported social barriers for patients.
- Providers in the Midwest and West reported higher burnout rates compared to other regions.

## Abstract

Introduction: Human immunodeficiency virus (HIV) infection can impact the physical health and psychological well-being of those who are infected and requires effective long-term management to achieve viral suppression. A patient’s ability to seek care is largely influenced by social determinants of health (SDOH) and the provider’s ability to help manage social needs.

Objectives: This study aims to elucidate how SDOH impacts the provider’s practice and well-being. We also assessed how provider burnout, which is significantly associated with feeling emotional exhaustion, plays a role in the patient-provider relationship.

Methods: This cross-sectional quantitative study was conducted at the Division of Infectious Diseases of the University of Kansas Medical Center, Kansas City, USA, with 86 providers who care for people living with HIV across the United States who completed an electronic survey about their perceptions of SDOH, barriers to social needs screening, and their personal experience of burnout. Providers identified several unmet social needs, such as financial instability, transportation, and appointment logistics, as major barriers for the patients to engage in HIV care. Data were analyzed using descriptive statistics and chi-square tests to evaluate associations between provider-related variables and provider burnout.

Results: Our results revealed that lack of access to social needs, such as financial instability, transportation, and appointment logistics, and insufficient time were barriers preventing clinicians from inquiring about social needs. We had a total of 86 respondents of healthcare providers: 95% were physicians and 5% were advanced practice practitioners (APPs). Moreover, 35% were located in the Midwest, 28% in the Northeast, 24% in the South, and 13% in the West regions of the United States. Survey respondents indicated that the following SDOH impacted their patients: 60% financial instability, 33% food insecurity, 33% face housing instability, and 49% transportation problems. Sixty-two percent (62%) of the providers reported feeling burned out. Burnout was most frequently reported among providers from the Midwest and the West. Among providers who felt burned out, 26% of those admitted receiving less support from staff and 57% feeling emotional exhaustion. There was a significant association between emotional exhaustion and those who felt burnout. Forty-eight percent (48%) of respondents indicated that they always or often encounter a lack of resources, and 35% identified the lack of time to discuss SDOH as a prominent barrier.

Conclusions: These findings suggest the importance of improving provider well-being and optimizing practices to effectively bridge the community with social services to ensure that people living with HIV remain engaged in care and attain the goal of viral suppression.