10:30am - 10:45am (CDT) | 3141.0 - Effects of a gender sensitive training for HIV providers on provider and client outcomes in central Uganda: A mixed methods pilot quasi-experimental controlled trial

Session: HIV Prevention and Care in International Settings

Program: HIV/AIDS

Authors:

Sten Vermund

Trace S. Kershaw, PhD

Abstract

Background

Interventions are needed to build providers’ capacity for delivering gender-sensitive HIV care to reduce known gender disparities in HIV care engagement in sub-Saharan Africa. In this study, we pilot tested a gender-sensitive training for HIV providers in Uganda.

Methods

We conducted a quasi-experimental controlled trial in 2022-23. The 4-session intervention, developed by the study team, focused on: gender norms; skills to respond to gendered HIV care barriers, stigma, and gender-based violence; bias recognition/reduction; and client-centered communication. Six clinics were matched (e.g., size, services) and randomly allocated to intervention or standard-of-care. We enrolled nearly all eligible HIV providers in both arms (N=144, 61 intervention, 83 control) and a cohort of clients with HIV, newly initiated on ART or struggling with adherence (N=238, 119 per arm). Participants completed structured questionnaires at baseline, 6- and 12-months, and training providers participated in an exit focus group or interview (n=53). We tested intervention effects using Generalized Estimating Equations and thematically analyzed qualitative data.

Results

We observed increased gender-sensitive care competence in intervention vs. control providers (Wald χ2 = 10.84, p = 0.004), which was corroborated by qualitative data highlighting gained gender knowledge, increased perceived importance of providing gender-sensitive care, as well as skills to do so. We observed no treatment differences in self-efficacy for client-centered communication. However, intervention providers reported increased empathy for clients (Wald χ2 = 150.43, p < 0.001) and qualitatively reported increased use of client-centered techniques (e.g., building rapport, empathy, eliciting the client’s agenda). Providers discussed increased recognition of and efforts to reduce gender and related biases towards clients (e.g., specific to women, men, gender diverse clients). We observed no treatment differences in client’s ART adherence or perceived quality of care indicators, but clients from intervention clinics reported greater HIV stigma reduction compared to control clinic clients (Wald χ2 = 9.46, p = 0.01).

Conclusions

This study provides preliminary support for a training intervention’s ability to affect the provision of gender sensitive, client-centered HIV care and to reduce provider bias, which may translate to HIV stigma reduction in HIV clients. Based on these pilot trial results, further testing is warranted.