Fogarty Fellow: Charles Osingada

Research Project

Perspectives of Ugandan patients, healthcare providers, and peer-educators about a telehealth solution addressing stigma and other barriers associated with HIV care and treatment

Human Immunodeficiency Virus (HIV) remains a huge public health challenge globally. Addressing barriers to engagement in the HIV care continuum is a key priority in ending the epidemic. Telehealth interventions have emerged as creative ways of engaging people living with HIV (PLWH) in HIV care and treatment. However, and despite technological capabilities, such interventions are a scarcity in low- and middle-income countries such as Uganda. A possible barrier to adoption into the healthcare delivery system is also a lack of provider competence or confidence and patient acceptability.

Given the widespread use of technological solutions in other aspects of Ugandan life, it is plausible telehealth solutions would be feasible, acceptable, and effective. We seek to address this knowledge and practice gap; using a mixed-methods approach we aim to 1) Identify factors associated with the likelihood of HIV-positive patients to accept and use a telehealth solution as part of their healthcare experience; and 2) Describe health care team members (peer educators, nurses, physicians) perspectives and attitudes, including perceived barriers and facilitators toward telehealth solutions for addressing stigma and other barriers associated with HIV care and treatment. Data will be collected through one-to-one in-depth interviews with peer-educators (n=20), nurses (n=20), and physicians (n=20) and a self-report survey from HIV positive patients (n=343) actively engaged in care and treatment. Descriptive statistics and conventional content analysis will be conducted to address the study's aim.

Traditionally HIV care and treatment have been provided through in-person visits with limited flexibility to accommodate patients who are experiencing challenges in accessing care at the clinics. However, the onset of the Severe Acute Respiratory Syndrome-CoV-2 (SARS-CoV-2) pandemic that plunged the entire global community into a public health crisis resulting in the rapid adoption of telehealth to maintain continuity of care for people living with HIV while preventing the spread of the Coronavirus. As the pandemic wanes there are growing demands to utilize lessons learned during the Coronavirus disease pandemic to build effective telehealth models for HIV care46. However, for such models to be useful particularly in low-income settings, they need to be contextually and culturally appropriated. So far evidence from high-income countries indicates that telehealth increases access to specialty care and it has high potential in addressing stigma and other factors identified as barriers to HIV care14. Also, literature emerging from developed countries suggests that telehealth models of care are acceptable to patients and healthcare providers, and it is a feasible approach to providing HIV care for patients living in rural areas. However, it is not known how people living with HIV and healthcare providers in low-income settings such as Uganda would respond to these services.

Equally important to know is how telehealth models trialed in developed countries would function under different sociocultural environments found in resource limited settings. Understanding these issues is critically important as we move towards integrating telehealth into the HIV care continuum. Presently, studies exploring these issues are lacking in low income settings even though the pay-off from such investigations would be rewarding given the high HIV and AIDS burden in these settings. To plug this gap, the proposed study aims at assessing perceptions of patients, healthcare providers, and peer-educators to a telehealth solution for addressing barriers to HIV care and treatment in Uganda. Upon completion of this study, we shall have insight into the feasibility of implementing a telehealth solution for addressing obstacles to HIV care and treatment. This will lay the ground for testing an innovative telehealth solution to address this problem.

Mentors

• Carolyn Porta, PhD, MPH, RN, University of Minnesota, USA
• Noeline Nakasujja, PhD, MBChB, MMedPsych, Makerere University, Uganda