Sileo K M, Wanyenze R K, Anecho A, Luttinen R L, Weston K, Mukasa B, Mukama S C, Vermund S H, Dworkin S L, Dovidio J F, Taylor B S, Kershaw T S
The Department of Discovery and Implementation for the Common Good, Connell School of Nursing, Boston College, Chestnut Hill, Boston, MA, USA.
Department of Public Health, The University of Texas at San Antonio, San Antonio, TX, USA.
BMC Public Health. 2025 May 24;25(1):1925. doi: 10.1186/s12889-025-23008-4.
Health workers play a critical role in providing gender-sensitive HIV care. However, without adequate training, they may inadvertently reinforce negative gender norms that hinder engagement in care. To improve ART services in sub-Saharan Africa, effective implementation strategies, including trainings, are essential.
This study evaluated the feasibility and acceptability of a novel 4-session, gender-sensitivity training for HIV health and lay workers in rural and peri-urban Uganda. We conducted a pilot quasi-experimental controlled trial in 2022-23, utilizing data from three sources: process data from 144 providers and 238 clients, qualitative post-intervention focus groups and interviews with 53 training attendees, and stakeholder interviews with 12 community leaders and facilitators. We employed thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR).
The training was highly rated by attendees via brief post-session surveys, with 99% of sessions deemed satisfactory. Qualitative feedback indicated that the sessions were perceived as appropriate for addressing providers' gaps in delivering gender-sensitive care and as beneficial for participants. High feasibility was evidenced by 100% of intervention steps delivered (fidelity checklists), 86% attendance (attendance logs), and 98.6% and 94.8% recruitment of eligible providers and clients (study records), respectively. Through qualitative exit focus groups, factors that positively affected acceptability and feasibility included tactics to gain support from supervisors, the use of experienced facilitators and active learning approaches, and the consideration of the health system context in delivery (e.g., cadre mix, location). Suggested improvements encompassed addressing interpersonal and structural barriers to client-centered care, incorporating community sensitization, streamlining content, and enhancing mentorship follow-ups. Stakeholders recognized the training's alignment with national health priorities and emphasized the need for clarity regarding its integration with existing training curricula and ongoing stakeholder engagement.
This study underscores the acceptability and feasibility of a gender-sensitivity training program for HIV providers; further evaluation of the program is warranted. Identified factors influencing implementation can inform enhancements to gender-focused training initiatives to improve the quality of HIV services and enhance client engagement and health outcomes.
Clinicaltrials.gov, NCT05178979, registered: November 15, 2021.
卫生工作者在提供对性别问题有敏感认识的艾滋病护理方面发挥着关键作用。然而，如果没有充分的培训，他们可能会无意中强化阻碍人们接受护理的负面性别规范。为了改善撒哈拉以南非洲的抗逆转录病毒治疗服务，包括培训在内的有效实施策略至关重要。
本研究评估了为乌干达农村和城市周边地区的艾滋病医护人员及非专业人员开展的为期4节的新型性别敏感性培训的可行性和可接受性。我们在2022 - 2023年进行了一项试点准实验对照试验，利用来自三个来源的数据：144名提供者和238名客户的过程数据、干预后对53名培训参与者进行的定性焦点小组讨论和访谈，以及对12名社区领袖和协调员进行的利益相关者访谈。我们采用了以实施研究综合框架（CFIR）为指导的主题分析。
通过简短的课后调查，参与者对培训给予了高度评价，99%的课程被认为令人满意。定性反馈表明，这些课程被认为适合解决提供者在提供对性别问题有敏感认识的护理方面的差距，并且对参与者有益。100%的干预步骤得到实施（保真度检查表）、86%的出勤率（出勤记录）以及分别98.6%和94.8%的合格提供者和客户招募率（研究记录）证明了高可行性。通过定性的结业焦点小组讨论，对可接受性和可行性产生积极影响的因素包括从上级获得支持的策略、使用经验丰富的协调员和积极的学习方法，以及在实施过程中考虑卫生系统背景（例如，人员构成、地点）。建议的改进措施包括解决以客户为中心的护理中的人际和结构障碍、纳入社区宣传、简化内容以及加强指导跟进。利益相关者认识到该培训与国家卫生优先事项相一致，并强调需要明确其与现有培训课程的整合以及持续的利益相关者参与。
本研究强调了针对艾滋病提供者的性别敏感性培训计划的可接受性和可行性；有必要对该计划进行进一步评估。确定的影响实施的因素可为以性别为重点的培训举措的改进提供参考，以提高艾滋病服务质量并增强客户参与度和健康结果。
Clinicaltrials.gov，NCT05178979，注册时间：2021年11月15日。
