Does Capacity Development Increase Demand for Health Services and Rights Among Key Populations Affected by HIV? A Systematic Review of Evidence from Low and Middle-Income Countries

Kiragu, Michael; Fonner, Virginia A.; Munyuwiny, Samuel; Izulla, Preston; Pantelic, Marija; Restoy, Enrique; Eiling, Ellen; O’Reilly, Kevin

doi:10.1007/s10461-020-02936-9

Cited by 6 publications

(11 citation statements)

References 34 publications

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“…Structural interventions are chronically under-funded and, with few exceptions, seldom supported for sufficiently long time periods to realize their benefits. Additionally, failure to prioritize program evaluation and implementation science studies of structural interventions has contributed to a dearth of information on these interventions in low-and middle-income contexts [22], despite the critical role these interventions might play in improving access to services and promoting accountability to human rights imperatives. Although we provide a limited glimpse into Project ACT here, our evaluation data provides a rich picture of advocacy's implementation and outcomes and points to critical areas for future investigation of communityled structural interventions to break down the barriers that prevent gay and bisexual men and transgender women from accessing HIV care.…”

Section: Resultsmentioning

confidence: 99%

“…Another recent review [22] examined studies in low-and middle-income countries in which "capacity development" interventions were assessed. In this instance, capacity development was broadly conceived as an effort to enhance the ability of individuals who were members of one or more key populations to claim their human rights and of dutybearing institutions to fulfill their attendant obligations to these rights holders.…”

Section: Structural Interventions To Reduce Stigma and Discriminationmentioning

confidence: 99%

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Breaking Down Barriers to HIV Care for Gay and Bisexual Men and Transgender Women: The Advocacy and Other Community Tactics (ACT) Project

2021

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Despite the prevailing consensus on the role that stigma and discrimination play in limiting access to HIV prevention technology, discouraging HIV testing, and impeding access to HIV care, studies that focus on structural interventions to address stigma and discrimination for gay, bisexual, and other men who have sex with men and transgender women are surprisingly uncommon. We aimed to identify the outcomes from a coordinated set of community-led advocacy initiatives targeting structural changes that might eliminate barriers to HIV care for gay and bisexual men and transgender women in five African and two Caribbean countries. We conducted a prospective evaluation that included repeated site visits and in-depth semistructured interviews with 112 people with direct knowledge of project activities, accomplishments, failures, and challenges. Using outcome harvesting and qualitative analysis methods, we observed that over the 18-month implementation period, local advocacy efforts contributed to enhanced political will on the part of duty bearers for ensuring equitable access to HIV care, increases in the availability of affirming resources, improved access to existing resources, and changes in normative institutional practices to enable access to HIV care. Evidence on Project ACT points to the vital role community-led advocacy plays in addressing stigma and discrimination as structural barriers to HIV care.

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Section: Resultsmentioning

confidence: 99%

Section: Structural Interventions To Reduce Stigma and Discriminationmentioning

confidence: 99%

Breaking Down Barriers to HIV Care for Gay and Bisexual Men and Transgender Women: The Advocacy and Other Community Tactics (ACT) Project

2021

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“…Our review also suggests that communities living with and disproportionately affected by HIV can effectively deliver services and influence policy. The comparative advantage of community-led HIV responses is predicated on several factors, including credibility with community members, ability to adapt to changing contexts and policy priorities, maintaining influence both within the community and at the policy level, community ownership, and iterative interactions and alliances with authorities resulting in accountability gains [ 31 , 68 , 115 ]. Likewise, several studies reiterated the point that having interventions that are community-based is insufficient for producing improved outcomes–interventions must be peer-led, of high quality, and possess strengthened capacity through skills training to ensure stronger, community-endorsed outcomes [ 57 , 94 , 116 ].…”

Section: Discussionmentioning

confidence: 99%

“…An international commitment to people-centred systems for health was enshrined in the United Nations (UN) 2021 Political Declaration on HIV and AIDS (“the Declaration”), building on strong commitments in the 2016 Political Declaration to ensure 30% of HIV service delivery would be community-led by 2030 [ 30 ]. In the 2021 Declaration, UN member States committed, as appropriate in the context of national programmes, to increase the proportion of HIV services delivered by community-led organizations to reach 30% of HIV testing and treatment services, 80% of HIV prevention services for high-risk populations, and 60% of programmes to achieve societally enabling environments by the year 2025 [ 31 – 33 ]…”

Section: Introductionmentioning

confidence: 99%

Peer- and community-led responses to HIV: A scoping review

Ayala

Sprague

Merwe³

et al. 2021

PLoS ONE

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Introduction In June 2021, United Nations (UN) Member States committed to ambitious targets for scaling up community-led responses by 2025 toward meeting the goals of ending the AIDS epidemic by 2030. These targets build on UN Member States 2016 commitments to ensure that 30% of HIV testing and treatment programmes are community-led by 2030. At its current pace, the world is not likely to meet these nor other global HIV targets, as evidenced by current epidemiologic trends. The COVID-19 pandemic threatens to further slow momentum made to date. The purpose of this paper is to review available evidence on the comparative advantages of community-led HIV responses that can better inform policy making towards getting the world back on track. Methods We conducted a scoping review to gather available evidence on peer- and community-led HIV responses. Using UNAIDS’ definition of ‘community-led’ and following PRISMA guidelines, we searched peer-reviewed literature published from January 1982 through September 2020. We limited our search to articles reporting findings from randomized controlled trials as well as from quasi-experimental, prospective, pre/post-test evaluation, and cross-sectional study designs. The overall goals of this scoping review were to gather available evidence on community-led responses and their impact on HIV outcomes, and to identify key concepts that can be used to quickly inform policy, practice, and research. Findings Our initial search yielded 279 records. After screening for relevance and conducting cross-validation, 48 articles were selected. Most studies took place in the global south (n = 27) and a third (n = 17) involved youth. Sixty-five percent of articles (n = 31) described the comparative advantage of peer- and community-led direct services, e.g., prevention and education (n = 23) testing, care, and treatment programs (n = 8). We identified more than 40 beneficial outcomes linked to a range of peer- and community-led HIV activities. They include improved HIV-related knowledge, attitudes, intentions, self-efficacy, risk behaviours, risk appraisals, health literacy, adherence, and viral suppression. Ten studies reported improvements in HIV service access, quality, linkage, utilization, and retention resulting from peer- or community-led programs or initiatives. Three studies reported structural level changes, including positive influences on clinic wait times, treatment stockouts, service coverage, and exclusionary practices. Conclusions and recommendations Findings from our scoping review underscore the comparative advantage of peer- and community-led HIV responses. Specifically, the evidence from the published literature leads us to recommend, where possible, that prevention programs, especially those intended for people living with and disproportionately affected by HIV, be peer- and community-led. In addition, treatment services should strive to integrate specific peer- and community-led components informed by differentiated care models. Future research is needed and should focus on generating additional quantitative evidence on cost effectiveness and on the synergistic effects of bundling two or more peer- and community-led interventions.

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“…Conforme demonstrado nos modelos de regressão logística, pessoas que se envolvem em ONGs recebem mais gel lubrificante, têm mais acesso a material educativo sobre prevenção sobre IST, palestra e aconselhamento sobre IST, assim como realizam mais testagem para sífilis e para o HIV, mesmo após ajuste por variáveis sociodemográficas e de acesso aos serviços de saúde. De forma semelhante, um estudo de revisão sistemática mostrou proporção significativamente maior no acesso a ações preventivas, incluindo uso de preservativos e lubrificantes, e na utilização dos serviços de saúde e de testagem entre HSH em intervenções focadas em mobilização comunitária e lideradas por pares 24 . Esses achados reforçam a recomendação de necessidade de ampliação de apoio a ações comunitárias das ONGs com envolvimento e engajamento da população de HSH, especialmente no que se refere a atividades de educação em saúde (participação em palestras, distribuição de material educativo, atividades de aconselhamento), nas quais os resultados apresentados mostram maior proporção relativa atribuída ao envolvimento em ONGs.…”

Section: Discussionunclassified

Envolvimento em organizações não governamentais e a participação em ações de prevenção ao HIV/aids por homens que fazem sexo com homens no Brasil

Almeida¹,

Guimarães²,

Dourado³

et al. 2021

Cad. Saúde Pública

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A epidemia do HIV no Brasil é concentrada em populações-chave. Organizações não governamentais (ONGs) que atuam em defesa dos direitos da população LGBT e de pessoas vivendo com HIV/aids podem contribuir para o desenvolvimento de políticas de prevenção. O objetivo deste estudo é avaliar o envolvimento em ONGs e analisar sua associação com a participação individual em ações de educação em saúde, testagem e prevenção às infecções sexualmente transmissíveis (IST) e ao HIV, como parte de um estudo nacional de vigilância biológica e comportamental entre homens que fazem sexo com homens (HSH). Trata-se de estudo transversal utilizando respondent driven sampling (RDS) em 12 cidades brasileiras. A magnitude da associação do envolvimento em ONGs com cada ação foi avaliada pela estimativa de odds ratio por meio de regressão logística por amostragem complexa, considerando cada cidade como um estrato e ponderando pelo estimador de Gile. Foi estimada a proporção relativa atribuída ao envolvimento em ONGs para cada evento avaliado. Dentre 4.176 participantes, a maioria tinha menos de 25 anos (56,5%) e baixo nível econômico (56,7%). Um quarto dos HSH referiu se envolver em ONGs, que foi significativamente associado com as ações avaliadas: receber preservativo e gel lubrificante, participar de palestra, receber material educativo e aconselhamento em IST, conhecimento de profilaxia pós-exposição (PEP) e profilaxia pré-exposição (PrEP), testagem para sífilis e HIV, ter aceitação do autoteste e saber onde realizar teste para HIV. ONGs têm um papel histórico na resposta à epidemia de HIV no Brasil e, apesar de terem sofrido significativa redução de recursos nos últimos anos, mantêm relevante atuação nas ações de saúde pública.

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Does Capacity Development Increase Demand for Health Services and Rights Among Key Populations Affected by HIV? A Systematic Review of Evidence from Low and Middle-Income Countries

Cited by 6 publications

References 34 publications

Breaking Down Barriers to HIV Care for Gay and Bisexual Men and Transgender Women: The Advocacy and Other Community Tactics (ACT) Project

Breaking Down Barriers to HIV Care for Gay and Bisexual Men and Transgender Women: The Advocacy and Other Community Tactics (ACT) Project

Peer- and community-led responses to HIV: A scoping review

Envolvimento em organizações não governamentais e a participação em ações de prevenção ao HIV/aids por homens que fazem sexo com homens no Brasil

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