A Gender Transformative Implementation Strategy with Providers to Improve HIV Outcomes in Uganda

摘要 抗逆转录病毒治疗(ART)是抗击艾滋病毒的唯一最有效的临床干预措施。然而， 在乌干达，2017年只有56%的艾滋病毒携带者被病毒抑制，差异很大 男性和女性之间的差异，表明在执行方面存在问题。虽然性别规范是一个已知的驱动因素 撒哈拉以南非洲的艾滋病毒差距，以及患者与提供者的关系是艾滋病毒护理的一个关键因素 在参与方面，很少有研究侧重于性别规范在制定公平条款方面的作用。 治疗和艺术咨询的质量。在本指导研究科学家中建议的培训计划 发展奖(K01)申请将提供校长所需的知识和技能 调查员，Katelyn M.Sileo，博士，公共卫生硕士，制定研究计划来调查和解决这些问题 问题。总体研究目标是制定和试行一项实施战略，以增加 提供者向艾滋病毒感染者提供公平和针对性别定制的治疗和咨询的能力 女人。向艾滋病毒提供者提供的这一为期4节的小组培训融合了性别变革的方法 采用调整后的循证战略，以减少偏见和提高性别平等态度。这个 将使用实施科学研究综合框架(CFIR)来指导全面的 为执行战略的发展提供信息的需求评估，包括定性数据 收集自诊所工作人员和领导层、患者和社区成员。实施战略将 通过准试验性延迟实施设计进行评估。卢韦罗和瓦基索的两家诊所 地区将被随机分配到仅培训(4个小组课程)或培训+(4个小组课程 加上额外的维护时段)条件，每隔6个月交叉一次。试点试验将 通过比较提供者(N=30-36)(性别)的变化来评估实施战略的有效性 意识和公平态度)和患者(N=240)结果(护理质量、满意度、临床 出勤率、抗逆转录病毒治疗依从性、病毒载量)，涵盖培训、培训+和18个月的日常护理。这个 审判还将定性地探索CFIR在执行和未来采用方面的障碍和促进者。这 研究项目配合课程作业、研讨会、学术会议、一对一指导，以及 手稿和赠款的编写将以以下三个培训目标为目标：(1)在以下领域发展专门知识 实施科学；(2)发展性别理论和促进性别平等的保健方面的专门知识 干预措施；(3)掌握执行科学评价方面的先进统计方法 研究设计。西里奥博士将接受一个由世界知名的艾滋病毒专家组成的跨学科团队的指导， 实施科学和性别意识形态。这个K01项目将把Sileo博士发展成一个独立的 专门研究利用实施科学来减少艾滋病毒结果中的性别差异的科学家。

Abstract Antiretroviral treatment (ART) is the single most effective clinical intervention in the fight against HIV. However, in Uganda only 56% of people living with HIV were virally suppressed in 2017 with significant disparities between men and women, suggesting problems with implementation. While gender norms are a known driver of HIV disparities in sub-Saharan Africa, and patient-provider relationships are a key factor in HIV care engagement, little research has focused on the role that gender norms have in shaping the equitable provision of treatment and quality of ART counseling. The proposed training plan in this Mentored Research Scientist Development Award (K01) application will provide the knowledge and skills needed for the principal investigator, Katelyn M. Sileo, PhD, MPH, to develop a program of research to investigate and address these issues. The overall research objective is to develop and pilot test an implementation strategy to increase providers' capacity to provide equitable and gender-tailored treatment and counseling to HIV-infected men and women. Delivered to HIV providers, this 4-session group training integrates a gender transformative approach with adapted evidence-based strategies to reduce biases and increase gender equitable attitudes. The Consolidated Framework for Implementation Science Research (CFIR) will be used to guide a comprehensive needs assessment to inform the development of the implementation strategy, including qualitative data collected from clinic staff and leadership, patients, and community members. The implementation strategy will be assessed through a quasi-experimental delayed implementation design. Two clinics in Luwero and Wakiso District will be randomly assigned to either the Training Only (4 group sessions) or Training+ (4 group sessions plus additional maintenance sessions) conditions, with cross-over in 6-month intervals. The pilot trial will assess the implementation strategy's effectiveness by comparing changes in provider (N=30-36) (gender awareness and equitable attitudes) and patient (N=240) outcomes (quality of care, satisfaction, clinic attendance, ART adherence, viral load) across Training, Training+, and Usual Care through 18-months. The trial will also qualitatively explore CFIR barriers and facilitators to implementation and future adoption. This research project paired with coursework, workshops, academic conferences, one-on-one mentorship, and manuscript and grant-writing will target the following three training aims: (1) Develop expertise in the field of implementation science; (2) Develop expertise in gender theory and gender transformative health interventions; (3) Gain mastery of advanced statistical methods in the evaluation of implementation science research designs. Dr. Sileo will be mentored by an interdisciplinary team of world-renowned experts in HIV, implementation science, and gender ideologies. This K01 project will develop Dr. Sileo into an independent scientist specializing in the use of implementation science to reduce gender disparities in HIV outcomes.