4:30pm - 6:00pm (CDT) | 4311.0 - Feasibility, acceptability, and barriers to implementation of novel health worker training to improve the provision of gender-sensitive HIV care in Uganda

Session: 2nd Round Table Presentation - HIV Treatment and Management

Program: HIV/AIDS

Authors:

Trace S. Kershaw, PhD

Sten Vermund

John Dovidio

Abstract

Background

Health workers play a critical role in delivering gender sensitive HIV care, but without proper training and support, they can deepen existing gender disparities (e.g., between men and women) through their treatment of clients. Implementation strategies, such as trainings, 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.

Methods

This study examined the feasibility, acceptability, and barriers/facilitators to the implementation and translation of a novel 4-session, gender-sensitive training delivered to HIV health and lay health workers in rural and peri-urban clinics in Uganda. A pilot quasi-experimental controlled trial was implemented in 2022-23. To examine Consolidated Framework for Implementation Science Research (CFIR) outcomes, we analyzed 1) process data from intervention participants (N=61), 2) qualitative, post-intervention data collected from intervention participants (focus groups or individual interviews, n=53), and 3) interview data from community stakeholders (e.g., intervention facilitators, health leaders, n=12). Data were analyzed through thematic analysis, guided by CFIR.

Results

The intervention was feasible and acceptable, with 86% of all training sessions attended and 99% of all sessions rated satisfactory or highly satisfactory by attendees. Post-intervention qualitative data also revealed high acceptability from providers and stakeholders, who considered gender-focused HIV programming a priority. The intervention was appropriate for providers in addressing gaps in providers’ motivation and skills to provide gender sensitive and client-centered care, to reduce gender bias and other stigma towards clients (e.g., towards men, sex workers, substance users), and to strengthen the implementation of gender-based violence (GBV) screening and response protocols. Barriers to translating content into practice included time/resource constraints limiting client-centered care, difficulty in overcoming all bias towards clients, and concern that following GBV protocols could erode community trust of providers. Factors impacting training feasibility/acceptability included support from supervisors, the use of experienced facilitators, and active learning approaches.

Conclusions

These data provide support for a gender-sensitive HIV provider training’s feasibility, acceptability, and appropriateness, supporting continued testing of this intervention. The identified barriers/facilitators to implementation/adoption can inform areas to strengthen in the future implementation of this and other gender-focused trainings in the region.