A Resiliency Intervention to Support Nurses Engaged in the Provision of HIV Care in KwaZulu-Natal, South Africa: Protocol for a Pilot Randomized Controlled Trial.

Background: South Africa has the largest HIV epidemic in the world; in KwaZulu-Natal Province, over 40.8% of adults aged 15 years and older are living with HIV. Despite this, South Africa is home to only 3% of the world's health care workers. Nurses constitute the largest group of providers in South Africa and experience high levels of burnout, which can contribute to negative patient outcomes for people living with HIV, including reduced treatment adherence. Nurse-centered interventions that offset these effects are urgently needed. Objective: This study aims to test the feasibility and acceptability of an adapted resiliency intervention (Stress Management and Resiliency Training-Relaxation Response Resiliency Program) for professional nurses who provide care for people living with HIV in South Africa. Methods: In phase 1 (Human Research Ethics Committee [Medical] of the University of the Witwatersrand [220813, Johannesburg, South Africa] and the Massachusetts General Brigham Institutional Review Board [2022P002765, Boston, Massachusetts, United States]), we conducted 3 focus group discussions to solicit feedback on the lived experiences of stress, sources of stress, impact on job functioning, coping strategies, the proposed intervention, and recruitment strategies for nurses. These data informed adaptations to the intervention. In phase 2 (Human Research Ethics Committee [240106, Johannesburg, South Africa]; Massachusetts General Brigham Institutional Review Board [2024P001407, Boston, Massachusetts, United States]), we conducted a small proof-of-concept study (N=8) with preintervention and postintervention assessments, 6 intervention sessions with a nurse interventionist, and a qualitative exit interview. Following appropriate adaptations, we conducted a pilot randomized controlled trial (N=60) in which participants were randomized to the intervention or the control condition. The control condition received a one-time, 90-minute didactic stress management session. The intervention condition consisted of two 4-hour group skills-based sessions on the relaxation response, components of stress, recuperative sleep, mindful awareness, resilience, and social support. Sessions included practice-based exercises and videos to complement the intervention materials. Baseline, posttreatment (intervention only), and follow-up assessments, as well as qualitative exit interviews (n=15, intervention only), were conducted. Primary outcomes are feasibility (number screened, eligible, and enrolled; the number of treatment sessions and assessments completed in the intervention arm; assessment duration; and reasons for declining enrollment and prematurely leaving the trial) and acceptability (Client Satisfaction Questionnaire-8 and qualitative data). Results: The project is funded by the National Institute of Mental Health (R34MH126753; September 2022). As of October 2025, we have completed both the proof-of-concept study (n=8; February 2025) and the pilot randomized controlled trial (n=60; August 2025). Data analysis is in progress and is expected to be completed in August 2026. Conclusions: Structural changes are needed to ensure the well-being of health care providers; however, given that structural changes take time, money, and political capital to execute, we must develop interventions to support providers' mental health while advocating for systematic change.