Assessing the effectiveness of HIV and AIDS service delivery models for key populations in Malawi
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Date
2021-07
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Kamuzu University of Health Sciences
Abstract
This is a mixed methods study that will use both quantitative and qualitative data. The quantitative part
will use secondary data collected as part of the Centre for the Development of People’s (CEDEP) routine
monitoring process for the periods – 2018/19 and 2019/20 focusing on five key variables (Key population
prevention messages - KP_PREV, HIV testing services - HTS_TST, HIV positive-HTS_POS, commodity
distribution, STI screening and diagnosed). The data will be collected using an excel template presented in
Annex 5. Qualitative data will be collected directly from men who have sex with men (MSM) and health
service providers (HSPs) that work with CEDEP in the delivery of HIV and AIDS services for MSM ).
The HSPs include CEDEP staff.
The problem:
Globally, Men who have sex with men (MSM) are at high risk of contracting and transmitting HIV but
have the least access to HIV prevention, care, and treatment services because their behaviours are often
stigmatized, and criminalized. In sub-Saharan Africa, same-sex behaviours have been largely neglected
by HIV research up to now. In Malawi, 7 % of MSM live with HIV and yet are also arrested if their sexual
orientation is exposed when seeking healthcare, causing many to shun HIV and other sexual health
services(1). Different models have been used to reach out to MSM with HIV and AIDS services. However,
the effectiveness of these models have not been fully investigated to guide KP programing. This study
therefore, will examine the different service delivery models currently being used to provide HIV and
AIDS services to MSM.
The objectives:
The broad objective of the study is to assess the effectiveness of the service delivery models employed
by CEDEP in reaching out to MSM with HIV and AIDS services (outreach, hybrid-public and private
facilities and drop-in centres). Specifically, the study will focus on the following objectives:
1. To identify Service delivery models that are high yielding.
2. To explore factors that contribute to high yielding in the identified service delivery models
3. To identify bottlenecks associated with the use of the different models employed by CEDEP;
4. To explore potential solutions for improving uptake of HIV and AIDS services by MSM.
Methodology
The study will use a mixed method approach. The quantitative part will use secondary data collected as
part of CEDEP’s routine monitoring process for periods - 2018/19 and 2019/20. CEDEP’s routine
monitoring data will be filtered to extract five key variables (Key population prevention messages - KP_PREV,
HIV testing services - HTS_TST, HIV positive-HTS_POS, commodity distribution, STI screening and diagnosed).
Quantitative data will be requested from CEDEP using the excel template present in Annex 5. Only routine
monitoring data for Lilongwe district will be used for this study. On the other hand, the qualitative partNgulube_P.04/21/3307_Version 2.0_20210610_Expedited 11
will rely on primary data to be collected directly from MSM using MSM interview guide (See Annex 1)
and health service providers (HSPs) including CEDEP staff that support MSM service delivery using the
HSP interview guide (See Annex 2).
The study will be done in Lilongwe targeting MSM accessing services at CEDEP service delivery points,
health service providers including CEDEP staff. Qualitative data will be collected from 49 MSM using
MSM interview guide (See Annex 1) and eight health service providers and five CEDEP staff using the
health service provider interview guide (See Annex 2). A combination of purposive and snowball
sampling techniques will be used to select 49 MSM who will respond to the MSM interview guide while
purposive sampling will be used to select 13 key informants to participate in the study (8 health service
providers, and 5 CEDEP staff). Qualitative data will be collected once the protocol receives approval from
COMREC.
Two data collectors will be hired to collect qualitative data from MSM using the MSM interview guide
while the principal researcher will collect qualitative data from key informants using interview guides.
Quantitative data will be analyzed using the Statistical Package for Social Sciences (SPSS). A Chi-Square
test will be used to test if there is any relationship between service delivery model and service uptake by
MSM. The test will focus on the three service delivery models (outreach, hybrid and DIC) on one side
and five service uptake indicators on the other side which include; Key population prevention messages -
KP_PREV, HIV testing services - HTS_TST, HIV positive-HTS_POS, commodity distribution, STI screening and
diagnosed. The reach data for the different services accessed at each service delivery point (outreach,
hybrid-public and private facilities and drop-in centres) will be plotted to show the trends over time
(2018/19 and 2019/20). Qualitative data will be summarized in word to extract the key themes and issues
coming out of the discussions which will then be analyzed to inform the findings and report writing.
Expected findings and their dissemination.
In recent years, the government has acknowledged the existence of MSM and the need to make health
services available to them. This study therefore is expected to identify the key service delivery models
that are high yielding and effective in reaching out to MSM with different HIV and AIDS services. This
will significantly contribute to the limited body of knowledge on MSM and provoke the debate on which
approaches could be cost-effective in reaching the MSM with the much need health services in an
environment where they are stigmatized and criminalized. The findings of the study will be shared with
key stakeholders (such as CEDEP, NAC, COM, MoH) who are actively involved in HIV service delivery
for MSM. The findings will also be submitted for consideration to be presented at local and international
HIV and AIDS dissemination conferences.