Systems change resulting from HIV/AIDS education and training. A cross-cutting evaluation of nine innovative projects

Psychological and Social Impact of HIV on Women Living with HIV and Their Families in Low- and Middle-Income Asian Countries: A Systematic Search and Critical Review

Human Immunodeficiency Virus (HIV) infection adds a significant burden to women in Low- and Middle-Income Countries (LMICs), often leading to severe detrimental impact, not only on themselves, but also on their families and communities. Given that more than half of all people living with HIV globally are females (53%), this review seeks to understand the psychological and social impact of HIV infection on Women Living with HIV (WLHIV) and their families in LMICs in Asia, and the interrelationships between one impact and another. A systematic review was conducted to find literature using the following databases: Medline, PsycINFO, CINAL, Emcare, Scopus and ProQuest. Research articles included in this review were selected based on the following inclusion criteria: conducted in LMICs in Asia, published in English language between 1 January 2004 and 31 December 2021, had full text available, involved WLHIV (married and unmarried) and explored the psychological and social impacts of HIV on these women and their families. Critical appraisal tools developed by Joanna Briggs Institute (JBI) were used to assess the methodological quality of the studies, and thematic narrative synthesis was used to analyse the findings. A total of 17 articles met the inclusion criteria. The review showed that HIV has a range of negative psychological consequences on WLHIV, such as stress, fear, worry, anxiety and depression, as well as social impacts on the women and their families, including stigma, discrimination and family separation. The findings indicate the need for targeted interventions—specific to WLHIV—that address the psychological challenges, stigma and discrimination these women and their families face. These interventions should also incorporate education and sustainable support structures for WLHIV and their families.

Changes in Clinician Ability to Assess Risk and Help Patients Determine the Need for Hiv Testing

An estimated one of four people with HIV in the United States do not know they have the infection. The Centers for Disease Control and Prevention encourages HIV testing in clinical settings, but there is evidence that this is not done on a regular basis. The purposes of this study were to (a) compare two less traditional teaching methods with a classroom method to determine whether the less traditional methods resulted in greater improvement of clinician knowledge, skill, and willingness to perform HIV risk assessment as the basis for recommending HIV testing; and (b) find out whether there were significant differences in convenience, cost, learner preference, or learner acceptance that would make one method more desirable than the others. Findings from participants in the standardized patient interaction with facilitator feedback (FB) and the case-based self-study module (SSM) were not different from those of participants in the interactive classroom education method (CL). Generally, there were positive changes in knowledge, attitudes, and behaviors over time. Participants preferred standardized patient interaction (FB) and interactive classes (CL) to self-study modules (SSM).

The use of emerging informatics techniques to evaluate the delivery of NMAETC programs to address HIV and AIDS disparities

BACKGROUND

Information technologies are employed to evaluate health program and better target recruitment of health care workforce for underserved communities, where needs for providers are greatest. With increased resources in reducing human immunodeficiency virus (HIV)/AIDS disparities and provider training, it may be important to know whether training is delivered in geographic areas where HIV/AIDS demonstrates high prevalence. The present study employs an informatics approach to identifying effectiveness of AIDS educational intervention in minority populations adversely affected by the disease. We seek to assess the National Minority AIDS Education and Training Center (NMAETC) on whether training activities are delivered appropriately in areas with high AIDS prevalence.

METHODS

A geographic information systems application was developed to relate NMAETC provider training activities to its spatial relationship of AIDS prevalence of 4 major US racial/ethnic groups (fiscal years 2005-2006). Trainees' locations were geocoded by zip code. We overlaid AIDS prevalence of major demographic communities by state with the US Census region and division boundaries to visually inspect the patterns of distribution and potential spatial association.

RESULTS

NMAETC training better targeted providers in 3 US Census regions and census divisions. The regions with higher provider training level generally corresponded to geographic areas with high AIDS prevalence for some minority populations. Additional efforts could be extended to recruit providers in the areas where the incidences were high for some communities.

CONCLUSIONS

Most NMAETC provider training activities occurred in the states with a high AIDS prevalence. Additional efforts could be extended to recruit the providers in those regions where HIV/AIDS are more prevalent for some minority populations.

A Structured Interview Approach to Evaluate HIV Training for Medical Care Providers

HIV/AIDS education trainings and self-reported changes in provider behavior resulting from the trainings were evaluated in a structured interview with 24 health care providers. The participants were asked to provide concrete examples of behavior changes related to eight specific areas in the provision of HIV/AIDS medical care. The structured interview process also served as an effective needs assessment of future training topics and of the modalities desired by the providers. The authors' results suggest that by carrying out a structured interview of training attendees, training programs can be more precisely evaluated, and strengths and gaps in overall HIV/AIDS provider education can be better identified and addressed.

Impact of HIV/AIDS education on health care provider practice: results from nine grantees of the Special Projects of National Significance Program

The study assessed the impact of health care provider HIV/AIDS education and training on patient care from nine Special Projects of National Significance. Telephone interviews were conducted with 218 health care providers within 8 months, on average, following completion of training. Respondents provided examples of how the SPNS trainings affected their provision of patient/client care. Transcribed comments reflecting change in patient/client care were classified by independent coders under 1 of 10 broad practice change categories. Eighty-two percent of the trainees identified at least one instance of change in patient/client care as a function of their training experience. Self-reported findings included changes in the number/types of patients seen, interpersonal interactions with patients/clients, HIV testing and counseling practices, patient/family education, infection control, advocacy, referrals and collaboration, documentation, and other service changes.