Studying the Barriers to HIV Care and Improving Services

Abt’s contributions to HIV-reduction efforts are multifaceted. We advance knowledge about HIV detection and care in the U.S. and improve HIV service delivery globally, among other efforts.

For example, we are working in Côte d’Ivoire to expand access to HIV services, in Namibia on HIV prevention, and in the U.S. to understand the barriers affecting the health professionals’ ability to provide HIV care to high-risk populations, including transgendered women.

Examining Barriers to HIV care for Transgender Women and MSM in the U.S.
Transgender women have a high risk for HIV infection and transmission – they had a 28 percent HIV prevalence rate, according to pooled data from four studies examined during a 2008 systematic review. Also, data from 18 studies involving participants’ self-reported HIV status indicated a 12 percent HIV prevalence rate.

HIV care providers need to consider both the physical and mental health of their patients, but many don’t have the resources and systems to track and follow up with patients to provide more consistent care.

— Cynthia Klein, Principal Associate, U.S. Health

Abt Global worked with Atlas Research to help the Centers for Disease Control and Prevention better understand the barriers experienced by transgender women when they try to access HIV treatment. Abt and Atlas carried out a study that included interviews with 40 transgender women – half of whom were HIV positive – and 10 health care providers. The study began in October 2015 and ended in May 2018.

This study is the third of three studies worked on by Abt and Atlas Research to assess HIV care barriers. The first study examined barriers reported by HIV care providers in three U.S. cities when they engage patients in care. The second focused on HIV care services for men who have sex with men (MSM) in one U.S. city. MSM bear a disproportionate share of the HIV burden in the U.S.

In this second study, Cynthia Klein—one of the project leaders and a principal associate for U.S. Health at Abt—said analysis revealed that funding decreases for HIV medical care and support services were an issue: “HIV care providers need to consider both the physical and mental health of their patients, but many don’t have the resources and systems to track and follow up with patients to provide more consistent care.”

“MSM patients said that stigma associated with HIV and their lifestyle created a barrier to seeking HIV care,” Klein said. “Also important was a lack of comprehensive health care services in areas of need. Abt also carried out an innovative mapping strategy, using observation data of event postings from a popular dating website and interview data. Analysis of mapping indicated that HIV testing is not always provided near the areas where MSM engage in high-risk behavior,” Klein said.

All of the studies are intended to inform CDC strategies for preventing and treating HIV among MSM and other high-risk populations.

Improving HIV Prevention and Service Delivery in Africa
The Private Sector Health Project (PSHP) in Côte d’Ivoire, funded by USAID and led by Abt, is expanding the network of private providers offering HIV and family planning (FP) services piloted under the Strengthening Health Outcomes through the Private Sector (SHOPS) project, which ended in January 2016. PSHP, a five-year, $10.9 million project, began in 2015.

Before SHOPS, private facilities in Côte d’Ivoire were not able to offer free antiretroviral therapy (ART).

“This new availability makes people feel more comfortable because they believe private facilities are more likely to protect their privacy,” said Dr. Alphonse Kouakou, PSHP’s Chief of Party. This confidentiality is an important factor in drawing more potential patients to the private sector for HIV care and treatment and increasing numbers of patients on ART.

Since SHOPS starting implementing activities in Cote d’Ivoire in 2014, more than 22,000 people have been tested and counseled on HIV, with 1,657 people testing positive. As of June 2016, 1,015 patients have been enrolled on ART – 108 percent of our target.

PSHP is working to improve interpersonal communication skills among network providers to enhance quality of care and increase patient retention in care. The project is providing the testing equipment as facilitating the acquisition of the necessary drugs.

In Namibia, the HIV work carried out by the Abt-led SHOPS project has transitioned to AIDS Free, a five-year, USAID-funded project led by JSI Research and Training. AIDS Free has a particular emphasis on service delivery and care.

Abt, as a subcontractor on AIDS Free, has brought together a network of over 70 private providers to perform voluntary medical male circumcision (VMMC), which is now covered by medical aid schemes in Namibia thanks to work done under the SHOPS project. VMMC reduces female-to-male HIV transmission by up to 60 percent and provides a protective effect to men who are circumcised. To increase demand for VMMC, we created a video about the procedure for men waiting in clinics for other reasons. 

“We also are starting a pilot program to provide VMMC services for free to men through an incentive program,” said Katherine Brouhard, a senior associate for Abt in International Health.

Visit our page on the 2018 International AIDS Conference.