Seed Funding and Mentorship Help Residencies Grow the HIV Clinician Workforce

More than four decades into the HIV epidemic, one of the most pressing challenges in American medicine is no longer the virus itself but the shrinking corps of clinicians equipped to treat it. Antiretroviral therapy has transformed HIV from a fatal diagnosis into a manageable chronic condition, and people with HIV now live long enough to require comprehensive primary care alongside antiretroviral management. Yet as prevalence has risen across the United States, the number of physicians with the capacity to deliver that care has declined, a shortfall that federal projections suggest will only worsen. A new pilot project, described in the Journal of General Internal Medicine, reports a practical and replicable strategy for reversing that trend by building specialized HIV training tracks directly into the residency programs that produce the nation’s primary care physicians.

The project was carried out by the National HIV Residency Pathway Consortium, or NHRPC, a steering committee of six national HIV leaders formed in February 2021. The group, which included two family medicine and four internal medicine experts representing five institutions and states, brought together decades of experience in HIV clinical care, training, and education. From the outset, the committee defined five goals: to establish a collaboration mechanism for HIV residency pathway leaders nationwide, to share best practices and resources, to help programs establish new pathways, to develop methods for evaluating program efficacy, and to identify solutions for the conspicuous deficit of pathway programs in the regions of the country where HIV is most prevalent.

HIV residency pathways are not a new idea. Since the first such track was established in 2006, more than 25 have appeared in family medicine and internal medicine residencies across the country, and more than 225 residents have graduated from them. Roughly 40 percent of those graduates now provide both primary and HIV care to people with HIV. But the geography of this educational effort has been strikingly mismatched with the epidemiology of the disease. Most existing pathways, and most of their graduates, are concentrated far from the areas of greatest need, particularly the Southern United States, where HIV prevalence is highest. The consortium’s central insight was that expanding the workforce would require deliberately seeding new pathways in those underserved, high-prevalence regions.

To test that idea, the steering committee implemented a one-year pilot project in 2023, funded by the Health Resources and Services Administration. From July 1, 2023, through June 30, 2024, the New England AIDS Education and Training Center, one of eight regional centers operating under Part F of the Ryan White HIV/AIDS Program, worked with the committee to recruit new or developing family medicine and internal medicine HIV pathways from high-prevalence areas. Interested programs submitted proposals that included a work plan, a budget justification, and a sustainability and evaluation plan. The committee judged applications on feasibility, on need as measured by local HIV prevalence, and on the experience and commitment of pathway directors and faculty in HIV care and education.

Six programs were selected, and each received 68,000 dollars in seed funding to start or expand its pathway. The money mattered more than its modest size might suggest. Across the six sites, 77.6 percent of the funds supported personnel costs, including protected time for faculty leadership, curriculum development, resident mentorship, and administrative coordination. The remainder went toward travel and conference attendance, recruitment and program development, and resident educational resources. All six awardees reported that securing this funding was essential to their pathway’s success, and four of the six said ongoing funding would be necessary to sustain their programs beyond the pilot year. The other two indicated that, while continued support would be beneficial, they could maintain some version of the pathway without it.

Beyond money, the project invested heavily in structured mentorship and peer support. Pathway faculty received monthly support through meetings that alternated among small-group sessions with steering committee mentors, larger sessions with the committee and all funded site directors, and consortium-wide gatherings. Over the project year, the steering committee held 21 mentoring meetings with individual pathway directors, averaging 3.5 per site, plus quarterly meetings with the six funded directors. The full consortium, which by then included 31 programs, met quarterly as well, drawing representation from 22 programs and an average of 13.6 participants per meeting. Topics ranged from clinical requirements and resident recruitment to evaluation and curricular resources. The organizers drew on the de Carvalho-Filho framework for building a community of practice for faculty development, and used Microsoft Teams for meetings, file sharing, and communication across the network.

A key deliverable of the pilot was the HIV Residency Pathway Toolkit, developed by the steering committee during the project year and refined through iterative feedback from HRSA and pathway directors. Launched in May 2024 on the website of the National AETC Support Center, the toolkit offers step-by-step guidance on nearly every operational question a new pathway faces: assessing local need and resources, creating a budget, designing a training model and didactics, establishing minimum clinic requirements, supporting faculty, and planning for sustainability. It also includes a comprehensive assessment schema built on previously published HIV-specific entrustable professional activities, mapped to the Accreditation Council for Graduate Medical Education’s milestones, along with faculty development in competency-based assessment. Pathway directors highlighted that seeing different options for structuring pathways, building schedules, and creating budgets was particularly helpful in organizing their own programs into coherent wholes.

The results of the pilot year were encouraging. Across the six sites, 24 residents matriculated into HIV pathways, six in family medicine and 18 in internal medicine. Recruitment was left entirely to the participating programs, and at the time of the report no participants had yet graduated. Evaluation combined process metrics with end-of-year survey responses from faculty and residents, with narrative comments coded thematically. Residents consistently reported developing a passion for integrated HIV and primary care, recognizing the impact of Ryan White funding and multidisciplinary care teams, and appreciating the complexities of caring for people with HIV. They reported greater confidence and strengthened clinical skills, and faculty independently observed the same growth. Many residents said the pathway influenced or reinforced their HIV-related career goals, with some describing newfound interest in outpatient medicine, in caring for people with HIV and other underserved populations, or in working at Ryan White-funded clinics.

Curriculum resources also proved their value. Every site used the publicly accessible, HRSA-funded National HIV Curriculum to track resident progress, and directors singled out its mini-lectures and podcasts as especially useful. Use of the HIV-specific entrustable professional activities was encouraged but not mandated; one pathway adopted 11 of the 12 during the pilot year, and four others planned to begin using them the following year. Directors also identified areas for improvement, including deeper collaboration with residency program leadership, more intentional modification of resident schedules to balance volume, breadth, and depth of patient contact, and earlier planning for conference attendance, since schedules are built months in advance. All pathways expressed the hope of continuing after the pilot year, pending institutional support.

The authors are candid about the limitations of their work. The short funding window and limited budget precluded a standardized pathway selection process, and the deliberate design of locally adaptable pathways may limit generalizability on a national scale. The findings reflect only the first year of implementation, without data on program growth, changes in resident confidence, patient satisfaction, or the long-term outcomes that matter most, such as workforce retention and career selection. Several programs reported that a single year of funding was disruptive, and the team’s experience suggests that at least two to three years are needed to launch sustainable pathways. Still, the pilot achieved its primary goal: catalyzing six new HIV training pathways in high-prevalence regions where few or none previously existed, and training 24 new residents in the process. The authors argue that novel, multi-year funding mechanisms should be developed to support and evaluate such pathways, and that the model could be adapted for other disciplines. As people with HIV continue to live longer and the clinician shortage deepens, this quietly pragmatic experiment offers a template for growing the HIV workforce exactly where it is needed most.

Subject of Research: Expansion of HIV residency training pathways to address the HIV clinician workforce shortage in high-prevalence regions of the United States

Article Title: Expanding the HIV Workforce Through Residency HIV Pathways

Article References: Budak, J. Z., Bositis, C., Day, P. G., Carson-Sasso, V., Hebert, S., Simpson, E. H., Chastain, C., Spach, D., Barakat, L., & Bolduc, P. (2026). Expanding the HIV Workforce Through Residency HIV Pathways. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10809-5

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10809-5

Keywords: HIV, residency training pathways, clinician workforce, graduate medical education, family medicine, internal medicine, Ryan White HIV/AIDS Program, mentorship, community of practice, health workforce shortage, primary care, HRSA