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

摘要 抗逆转录病毒治疗（ART）是对抗艾滋病毒的唯一最有效的临床干预措施。然而，在这方面， 在乌干达，2017年只有56%的艾滋病毒感染者受到病毒抑制，差异显著 男性和女性之间的差异，这表明了实施方面的问题。虽然性别规范是一个已知的驱动因素， 在撒哈拉以南非洲，艾滋病毒的不平等和病人与提供者的关系是艾滋病毒护理的关键因素 参与，很少有研究集中在性别规范在塑造公平规定方面的作用 治疗和ART咨询的质量。本指导研究科学家的拟议培训计划 发展奖（K 01）申请将提供校长所需的知识和技能 调查员凯特琳·M Sileo，博士，公共卫生硕士，制定研究计划，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执行战略， 提供者向感染艾滋病毒的男子提供公平和针对性别的治疗和咨询的能力， 妇女提供给艾滋病毒提供者，这4个会议的小组培训纳入了性别变革的方法 采用经调整的循证战略，减少偏见，提高两性平等态度。的 实施科学研究综合框架（CFIR）将用于指导一项全面的 进行需求评估，为制定执行战略提供信息，包括质量数据 从诊所工作人员和领导，病人和社区成员收集。执行战略将 通过准实验性延迟实施设计进行评估。卢韦罗和瓦基索的两个诊所 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 加上额外的维护会话）条件，以6个月为间隔进行交叉。试点试验将 通过比较提供者（N=30-36）（性别）的变化来评估实施策略的有效性 意识和公平态度）和患者（N=240）结局（护理质量、满意度、临床 参加率、ART依从性、病毒载量）。的 试验还将定性地探讨CFIR实施和未来采用的障碍和促进因素。这 研究项目与课程，研讨会，学术会议，一对一的导师配对， 论文和赠款写作将针对以下三个培训目标：（1）发展在以下领域的专门知识： 实施科学;（2）发展性别理论和性别变革健康方面的专门知识 （3）掌握先进的统计方法，评估实施科学 研究设计。Sileo博士将接受由世界知名艾滋病毒专家组成的跨学科团队的指导， 执行科学和性别意识形态。这个K 01项目将把Sileo博士发展成为一个独立的 科学家，专门研究如何利用实施科学来减少艾滋病毒成果中的性别差异。

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.