Abstract
Antiretroviral treatment (ART) is the single most effective clinical intervention in the fight against HIV. However,
in Uganda only 56% of people living with HIV were virally suppressed in 2017 with significant disparities
between men and women, suggesting problems with implementation. While gender norms are a known driver
of HIV disparities in sub-Saharan Africa, and patient-provider relationships are a key factor in HIV care
engagement, little research has focused on the role that gender norms have in shaping the equitable provision
of treatment and quality of ART counseling. The proposed training plan in this Mentored Research Scientist
Development Award (K01) application will provide the knowledge and skills needed for the principal
investigator, Katelyn M. Sileo, PhD, MPH, to develop a program of research to investigate and address these
issues. The overall research objective is to develop and pilot test an implementation strategy to increase
providers' capacity to provide equitable and gender-tailored treatment and counseling to HIV-infected men and
women. Delivered to HIV providers, this 4-session group training integrates a gender transformative approach
with adapted evidence-based strategies to reduce biases and increase gender equitable attitudes. The
Consolidated Framework for Implementation Science Research (CFIR) will be used to guide a comprehensive
needs assessment to inform the development of the implementation strategy, including qualitative data
collected from clinic staff and leadership, patients, and community members. The implementation strategy will
be assessed through a quasi-experimental delayed implementation design. Two clinics in Luwero and Wakiso
District will be randomly assigned to either the Training Only (4 group sessions) or Training+ (4 group sessions
plus additional maintenance sessions) conditions, with cross-over in 6-month intervals. The pilot trial will
assess the implementation strategy's effectiveness by comparing changes in provider (N=30-36) (gender
awareness and equitable attitudes) and patient (N=240) outcomes (quality of care, satisfaction, clinic
attendance, ART adherence, viral load) across Training, Training+, and Usual Care through 18-months. The
trial will also qualitatively explore CFIR barriers and facilitators to implementation and future adoption. This
research project paired with coursework, workshops, academic conferences, one-on-one mentorship, and
manuscript and grant-writing will target the following three training aims: (1) Develop expertise in the field of
implementation science; (2) Develop expertise in gender theory and gender transformative health
interventions; (3) Gain mastery of advanced statistical methods in the evaluation of implementation science
research designs. Dr. Sileo will be mentored by an interdisciplinary team of world-renowned experts in HIV,
implementation science, and gender ideologies. This K01 project will develop Dr. Sileo into an independent
scientist specializing in the use of implementation science to reduce gender disparities in HIV outcomes.