Resilience outcomes and associated factors among workers in community-based HIV care centres during the Covid-19 pandemic: A multi-country analysis from the EPIC program

Introduction: Community health workers (CHW) were integral in the COVID-19 response, particularly concerning services for populations vulnerable to HIV. Little is known regarding the mental health of CHW during the COVID-19 crisis. The objective of this study was to study resilience of CHW working in HIV non-governmental organizations.

Methods: An anonymous online, cross-sectional questionnaire was implemented during 2021 among CHW in Benin, Colombia, Guatemala, and Spain. Three scales were used to assess mental health: the 6-item Brief-Resilience Scale, the 9-item Patient Scale Questionnaire and the 7-item Generalized-Anxiety-Disorder scale. Logistic regression models were used to identify factors associated with "low" resilience vs "normal" or "high" resilience.

Results: Among 295 respondents, the median standardized resilience score was 58.33 (IQR = [50.0-75.0], n = 267), 18.52 (IQR = [7.4-33.3], n = 282) for standardized depression score and 19.05 (IQR = [4.8-33.3], n = 274) for standardized anxiety score. Standardized resilience score was negatively correlated with standardized anxiety score (rho = -0.49, p < 0.001, n = 266) and standardized depression score (rho = -0.44, p < 0.001, n = 267).

Conclusions: Normal or high level of resiliency in the HIV CHW were observed during the COVID-19 crisis. Self-efficacy, through COVID-19 prevention training, was a factor associated with resilience. Health policy must place CHW at the core of the healthcare system response to Covid-19 and to future health emergencies, as they ensure continuity of care for many diseases including HIV among vulnerable populations.