Challenges of NGO-to-state Referral in the Delivery of HIV Prevention Programs in Ukraine Supported by the Global Fund

Background: Ukraine has one of the world’s fastest growing HIV rates and was one of the largest recipients of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF). The objective of this study was to close the gaps in the literature on the delivery of HIV prevention services by NGOs and the perceptions of NGO delivered services, using as an example HIV prevention programs in Ukraine funded by the GF.Methods: The aim of this qualitative study was to determine how NGO-based services were implemented in the context of a state-owned healthcare system of Ukraine. An ethnographic study, which included 50 participant interviews, was conducted in three oblasts in Ukraine and in the capital, Kyiv, between 2011 and 2013. This article presents some of the findings that emerged from the analysis.Results: Participants reported that NGOs were focused more on reporting numbers of rapid tests, and less on motivating clients to continue onto treatment. The role division between NGOs and the state in HIV services was largely perceived by participants as unclear and challenging. Overall, lack of clarity on the role of government healthcare providers and NGOs in providing HIV services compromised the process of finding, referring, and retaining HIV patients in care.Conclusions: Gaps in linking HIV patients to the HIV care continuum have been identified as a potentially problematic issue in delivery of HIV prevention services by GF funded NGOs. With an anticipated GF exit from Ukraine, the lack of clearly defined NGO-to-state referrals of HIV patients complicates the transition of NGO run services into state funding. Further steps to improve referral systems are necessary to ensure a smooth transition and enable Ukraine to fight its HIV epidemic effectively.

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Remembering the Children: Implementation and Success of a Robust Method for Identifying and Testing Children of HIV Patients

Journal of Sexually Transmitted Diseases ◽

10.1155/2013/828024 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6

Author(s):

Christopher Darlow ◽

Peter Tovey ◽

Fiona Wallis ◽

Clare Knowles ◽

Ian Fairley ◽

...

Keyword(s):

At Risk ◽

Healthcare Providers ◽

Safety Net ◽

Robust Method ◽

Children At Risk ◽

Hiv Patients ◽

Hiv Services ◽

Undiagnosed Hiv ◽

User Friendly ◽

Hiv Negative

Background. Children of HIV patients are a historically neglected demographic by HIV services. It has been recommended by CHIVA that HIV services have a robust method of detecting and testing untested children. We note that no such method is either in widespread use or in the literature. Method. In December 2011, a one-page proforma to identify HIV untested children and a clear multidisciplinary pathway to test them were implemented. Twelve months later the uptake of the proforma and pathway, the numbers of patients and children identified for testing, and their outcomes were audited. Results. The proforma was completed in 192/203 (94.6%) eligible patients. Twenty-five (21.5%) of 118 identified offspring had not been tested. Ten (8.5%) of these were <18 years old. All were reported to be clinically well. Ten children were referred for testing, seven were tested immediately, and three were tested within 18 months of identification. All children were tested HIV negative. Discussion. We have identified a method of identification that is easy and robust and provides a user-friendly safety net to empower healthcare providers to identify and test children at risk. We recommend the implementation of such strategies nationwide to prevent death due to undiagnosed HIV in children.

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Healthcare providers and community perspectives on expedited partner therapy (EPT) for use with gay, bisexual and other men who have sex with men

Sexually Transmitted Infections ◽

10.1136/sextrans-2019-054156 ◽

2019 ◽

Vol 96 (2) ◽

pp. 101-105 ◽

Cited By ~ 1

Author(s):

Kristi E Gamarel ◽

Raha Mouzoon ◽

Alejandro Rivas ◽

Rob Stephenson ◽

Okeoma Mmeje

Keyword(s):

Hiv Prevention ◽

Insurance Coverage ◽

National Level ◽

Healthcare Providers ◽

Cultural Humility ◽

Community Members ◽

Potential Barriers ◽

Prevention Services ◽

Expedited Partner Therapy ◽

Sex With Men

ObjectivesExpedited partner therapy (EPT) is an effective strategy to reduce rates of chlamydia and gonorrhoea infection and ensure sexual partners are treated. Currently, EPT is provided to heterosexual patients; however, EPT is not routinely recommended for use with gay, bisexual and other men who have sex with men (GBMSM) because of concerns about HIV coinfection. The objective of the qualitative study was to understand provider and community views on the use of EPT with GBMSM.MethodsUsing convenience sampling methods, we recruited a sample of 18 healthcare providers and 21 GBMSM to participate in in-depth, semistructured interviews. Interviews were conducted over the phone and included questions about knowledge, experiences and potential barriers and facilitators to the use of EPT with GBMSM.ResultsMost providers wanted to provide EPT to GBMSM and believed that the potential barriers and concerns to EPT use were not unique to a patient’s sexual orientation. Several providers noted that they were currently providing EPT to GBMSM as part of HIV prevention services. Community members were generally unaware of EPT as a service and most indicated that they would only use EPT if they were in a committed relationship. Barriers included partner allergies and resistance, pharmacy protocols, structural concerns (eg, insurance coverage, pharmacists onsite and transportation) and potential disclosure issues. Facilitators included cultural humility and telemedicine with patients’ partners to overcome these barriers.ConclusionsAcceptability of EPT use for both chlamydia and gonorrhoea was high among providers and community members. Barriers to EPT use, including concerns about patients’ partners’ allergies and resistance, disclosure concerns and linkage to HIV prevention services can be overcome through cultural humility trainings and telemedicine. Changing EPT recommendations at the national level to be inclusive of GBMSM is critical to curtail the rising STI and HIV epidemic.

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‘Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)’: protocol of community-based intervention development and a non-randomised multisite pilot study with pre–post test design in Canada

BMJ Open ◽

10.1136/bmjopen-2019-034144 ◽

2020 ◽

Vol 10 (7) ◽

pp. e034144

Author(s):

Ashley Lacombe-Duncan ◽

Carmen H Logie ◽

Yasmeen Persad ◽

Gabrielle Leblanc ◽

Kelendria Nation ◽

...

Keyword(s):

Pilot Study ◽

Hiv Prevention ◽

Healthcare Providers ◽

Intervention Development ◽

Hiv Care ◽

Test Design ◽

Community Based ◽

Trans People ◽

Post Test ◽

Trans Women

IntroductionEducational workshops are a promising strategy to increase healthcare providers’ ability to provide gender-affirming care for transgender (trans) people. This strategy may also reduce healthcare providers’ stigma towards trans people and people living with HIV. There is less evidence, however, of educational workshops that address HIV prevention and care among trans women. This protocol details development and pilot testing of the Transgender Education for Affirmative and Competent HIV and Healthcare intervention that aims to increase gender-affirming HIV care knowledge and perceived competency, and to reduce negative attitudes/biases, among providers.Methods and analysisThis community-based research (CBR) project involves intervention development and implementation of a non-randomised multisite pilot study with pre–post test design. First, we conducted a qualitative formative phase involving focus groups with 30 trans women and individual interviews with 12 providers to understand HIV care access barriers for trans women and elicit feedback on a proposed workshop. Second, we will pilot test the intervention with 90–150 providers (n=30–50×3 in-person settings). For pilot studies, primary outcomes include feasibility (eg, completion rate) and acceptability (eg, workshop satisfaction). Secondary preintervention and postintervention outcomes, assessed directly preceding and following the workshop, include perceived competency, attitudes/biases towards trans women with HIV, and knowledge needed to provide gender-affirming HIV care. Primary outcomes will be summarised as frequencies and proportions (categorical variables). We will conduct paired-sample t-tests to explore the direction of preintervention and postintervention differences for secondary outcomes.Ethics and disseminationThis study has been approved by the University of Toronto HIV Research Ethics Board (Protocol Number: 00036238). Study findings will be disseminated through community forums with trans women and service providers; manuscripts submitted to peer reviewed journals; and conferences. Findings will inform a larger CBR research agenda to remove barriers to engagement in HIV prevention/care among trans women across Canada.Trial registration numberNCT04096053; Pre-results.

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Enhancing domestic violence advocates’ ability to discuss HIV pre-exposure prophylaxis (PrEP): Feasibility and acceptability of an educational intervention

Women s Health ◽

10.1177/17455065211070548 ◽

2022 ◽

Vol 18 ◽

pp. 174550652110705

Author(s):

Tiara C Willie ◽

Laurel Sharpless ◽

Mauda Monger ◽

Trace S Kershaw ◽

Wendy B Mahoney ◽

...

Keyword(s):

Domestic Violence ◽

Intimate Partner Violence ◽

Hiv Prevention ◽

Partner Violence ◽

Self Efficacy ◽

Intimate Partner ◽

Hiv Care ◽

Post Intervention ◽

Prevention Services ◽

Exposure Prophylaxis

Background: Survivors of intimate partner violence are at elevated risk for HIV acquisition, yet there is limited research on the best strategies to optimize biomedical HIV prevention, such as pre-exposure prophylaxis among this population. Domestic violence agencies are critical collaborating partners and function as potential entry points into HIV prevention services for survivors; however, limited knowledge regarding HIV prevention has been an important barrier to advocate-led discussions. This study aimed to develop, implement, and evaluate an HIV prevention intervention for domestic violence advocates. Setting: A nonrandomized, group-based intervention with pre-intervention, immediate post-intervention, and 3-month post-intervention periods were conducted with multiple domestic violence agencies in Mississippi. Methods: Overall, 25 domestic violence advocates participated in the two-session intervention. Surveys were administered to assess pre-exposure prophylaxis knowledge, self-efficacy, subjective norms, and willingness to provide HIV prevention services to intimate partner violence survivors. Generalized estimating equations were conducted to assess change in behavioral outcomes over time. Results: Compared to pre-intervention, there were significant increases at immediate and 3-month post-intervention in advocates’ intervention acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to provide HIV prevention information, discuss pre-exposure prophylaxis eligibility criteria, assist pre-exposure prophylaxis-engaged clients, and initiate pre-exposure prophylaxis counseling. Conclusion: This group-based intervention enhanced domestic violence advocates’ acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to offer HIV care information, discuss pre-exposure prophylaxis eligibility, assist pre-exposure prophylaxis-engaged survivors, and initiate pre-exposure prophylaxis counseling with intimate partner violence survivors. Efforts should focus on training domestic violence advocates in HIV prevention care for survivors and also include these agencies in collaborative strategies to reduce HIV incidence.

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Barriers to and Facilitators of Accessing HIV Services for Street-Involved Youth in Canada and Kenya

10.21203/rs.3.rs-1181780/v1 ◽

2022 ◽

Author(s):

Momina Khan ◽

Katie MacEntee ◽

Reuben Kiptui ◽

Amy Berkum ◽

Abe Oudshoorn ◽

...

Keyword(s):

Public Policy ◽

Hiv Prevention ◽

Health Care Providers ◽

Healthcare Providers ◽

Educational Outreach ◽

High Risk Population ◽

Hiv Education ◽

Care Providers ◽

Community Based ◽

Hiv Services

Abstract Introduction: UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of Peer Navigators to increase access to HIV services.Methods: Semi-structured interviews, focus group discussions (FGD), and Theatre Testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM).Results: Across the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services.Conclusions: Intersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites.

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Pre-Exposure Prophylaxis (PrEP) Uptake among Black Men Who Have Sex with Men (BMSM) in the Southern U.S.

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189715 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9715

Author(s):

Oluwafemi Adeagbo ◽

Sayward Harrison ◽

Shan Qiao ◽

Xiaoming Li

Keyword(s):

Hiv Prevention ◽

Black Men ◽

Healthcare Providers ◽

Rapid Expansion ◽

Hiv Care ◽

Hiv Incidence ◽

Interdisciplinary Approaches ◽

Sex With Men ◽

Exposure Prophylaxis ◽

The U.S

Black men who have sex with men (BMSM) living in the United States (U.S.) South are disproportionately affected by HIV and experience significant disparities in HIV incidence, access to HIV care, and prevention across ages and socio-economic statuses. The aim of this commentary is to critically review current literature on the state of PrEP use among BMSM in the U.S. South, including identifying barriers and facilitators to PrEP use in order to inform intervention development. Extant literature shows that despite the documented benefits of PrEP as an effective HIV-prevention method, its uptake among BMSM is limited across the U.S. South. Common barriers to PrEP uptake included stigma, homophobia, mistrust of healthcare systems, negative attitudes from healthcare providers, access and transportation issues, poverty, and misinformation about PrEP. These barriers are likely to have been further exacerbated by the COVID-19 pandemic. Limited access to PrEP and other HIV-prevention programs, such as HIV testing, post-exposure prophylaxis (PEP), and condoms for BMSM are likely increase HIV incidence in this community. Moreover, the rapid expansion of telehealth services during the COVID-19 period may offer increased opportunity to scale-up PrEP through telehealth interventions, especially if in-person services remain limited due to pandemic precautions. Given the intersectional barriers that limit the access and uptake of PrEP among BMSM, we suggest that tailored programs or interventions that seek to address PrEP disparities among Southern BMSM should adopt intersectional and interdisciplinary approaches to better understand the complex challenges of scaling up PrEP. More studies are needed to investigate the impact of COVID-19 on HIV-prevention services among BMSM and to understand how to co-develop—with the BMSM community and healthcare providers—culturally acceptable interventions to reduce the identified challenges using intersectional and interdisciplinary approaches.

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Partners or donors: The perceived roles of Global Fund Principal Recipient NGOs in HIV prevention programmes in Ukraine

Journal of Eurasian Studies ◽

10.1016/j.euras.2016.11.005 ◽

2017 ◽

Vol 8 (1) ◽

pp. 97-105 ◽

Cited By ~ 1

Author(s):

Svetlana McGill

Keyword(s):

Civil Society ◽

Hiv Prevention ◽

Global Fund ◽

State Funding ◽

External Funding ◽

Hiv Services ◽

Doctoral Research ◽

Vertical Relations ◽

Prevention Programmes

Ukraine has one of Europe's fastest growing HIV rates and in 2003–2012 was one of the largest recipients of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF). Doctoral research recently completed by the author investigates the conduct and practice of international and national nongovernmental organisations (NGOs) as Principal Recipients (PRs) of GF grants in Ukraine from 2003 to 2012. An ethnographic enquiry including 50 participant interviews was conducted in three oblasts in Ukraine, and in its capital, Kyiv. The paper presents some of the findings that emerged from the analysis. Discussing the PR NGOs roles and practices in delivering HIV prevention programmes funded by GF, the author argues that the anticipated benefits of NGO partnerships between PR NGOs and their Sub-Recipients (SRs) have not been achieved. Rather, PRs acted as donors and ran highly discretionary policies in channelling GF funding to SRs that installed competition and vertical relations between NGO-grantors and NGO-grantees. The outcome was a servile civil society that is dependent on external funding and is unable to genuinely represent their communities. With an anticipated GF phasing out from Ukraine, there is a critical lack of advocacy potential of the civil society to articulate and defend the needs of PLHIV when transferring HIV services into state funding.

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PREDICTORS OF ADHERENCE TO HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) AMONG HIV PATIENTS ATTENDING SELECTED COMPREHENSIVE CARE CENTRES (CCC) IN KERICHO COUNTY

Journal of Health, Medicine and Nursing ◽

10.47604/jhmn.1191 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1

Author(s):

Kipkirui Collins Cheruiyot ◽

Dennis Magu ◽

Daniel Mokaya

Keyword(s):

Antiretroviral Therapy ◽

Highly Active Antiretroviral Therapy ◽

Healthcare Providers ◽

Comprehensive Care ◽

Hiv Care ◽

Inferential Statistics ◽

Hiv Patients ◽

Highly Active ◽

Predictors Of Adherence ◽

Optimal Adherence

Purpose: The main objective of the study was to determine Predictors of adherence to Highly Active Antiretroviral Therapy among HIV patients attending selected comprehensive care centres in Kericho County. Specifically, this study sought to determine the socio-demographic and socio-economic factors that affect adherence HAART. Methodology: A descriptive cross-sectional study was used. It involved 280 HIV patients (≥ 15 years) on HAART in three selected Comprehensive Care Centres in Kericho County. Data was collected from the patients using interviewer administered semi-structured questionnaires while Key informant interviews were held with healthcare providers involved in HIV care at the selected facilities. Viral load was used as a measure of adherence. This was done by retrospective review of the patient files. The three facilities where this study was done were picked using purposive sampling. systematic sampling was then utilized to attain the calculated sample size for each facility. Data was entered into Statistical Package for Social Sciences (SPSS) version 25.0 and analysis was done through descriptive and inferential statistics. Descriptive statistics; frequencies and percentages was used to summarize the data set. Inferential statistics was done using logistic regression analysis (Univariate and multivariate). The p-value was set at 0.05.Summary statistic of independent variables was presented using frequency tables, pie charts and bar graphs. Findings: 76% of the respondents had optimal adherence while 24% had sub-optimal adherence. More females than males were on treatment. There was an insignificant difference in adherence between males and females. Only age (category 20-24 years) p=0.023 and expenditure on food(p=0.04) had significant association with adherence to HAART. Unique contribution to theory, practice and policy: An understanding of these predictors will allow for targeted interventions to increase adherence to HAART and improve the health outcomes of PLHIV. Healthcare providers will be able to develop educational programmes and materials that target HIV patients at risk of sub-optimal adherence.

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Conducting HIV Prevention Programs for the Severely Mentally Ill

Californian Journal of Health Promotion ◽

10.32398/cjhp.v4i2.1935 ◽

2006 ◽

Vol 4 (2) ◽

pp. 76-80 ◽

Cited By ~ 1

Author(s):

Ihor Perehinets ◽

Edward Mamary ◽

Valerie Rose

Keyword(s):

Hiv Prevention ◽

San Francisco ◽

Mentally Ill ◽

Prevention Program ◽

Prevention Programs ◽

Prevention Services ◽

Telephone Interviews ◽

Severely Mentally Ill ◽

A Priority ◽

Priority Population

Recent studies have shown that the severely mentally ill (SMI) are at higher risk for HIV infection than the general population. At the same time, the number of HIV prevention programs available for this priority population is extremely low. The purpose of this study was to identify the extent to which community-based organizations conduct HIV prevention for severely mentally ill people. Telephone interviews with HIV prevention program managers in San Francisco were conducted over two weeks in 2003. Of the 21 agencies funded by the San Francisco Department of Public Health, only three agencies included severely mentally ill people as a priority population for their prevention efforts. However, 16 agencies reported that they provided prevention services to the SMI, even though they were not considered a priority risk population. Three providers reported no SMI among the population they served. Additional studies are also needed to examine the capacity building elements that are necessary for HIV prevention program providers to plan, design, and implement prevention programs tailored for SMI individuals.

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Ten Core Principles of Effective HIV Prevention Programs for Adolescents

PsycEXTRA Dataset ◽

10.1037/e705492007-001 ◽

2007 ◽

Cited By ~ 1

Author(s):

Barbara L. Ingram ◽

Mary Jane Rotheram-Borus ◽

Amy Elkavich

Keyword(s):

Hiv Prevention ◽

Prevention Programs

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