1032- Uganda- Optimizing Implementation of Community- and Facility-Based Differentiated Service Delivery Models for HIV Treatment in Uganda

In Uganda, 1.2 million persons are receiving lifelong antiretroviral therapy (ART), which presents challenges to the long-term sustainability of HIV care and treatment delivery. In response, less-intensive differentiated service delivery models (DSDM) have recently been introduced in sub-Saharan Africa, including Uganda, with marked success. These patient-centered models offer flexible, convenient options for ART provision to persons who are stable on HIV treatment while de-densifying overcrowded health facilities. DSDM include ART pickup/refill models in community (out-of-facility) and facility (clinic-based) settings.

DSDM have only recently been scaled up, and there has been limited study of DSDM implementation in populations beyond special groups (e.g., adolescents, pregnant women), whose distinct HIV care needs rendered them priorities for early DSDM pilots. Continued expansion of DSDM to general patient populations in Uganda, where 65% of persons on ART are enrolled in an out-of-facility or clinic-based DSDM, underscores the critical role of research in guiding ongoing DSDM implementation and scale-up efforts. Despite burgeoning research into the health-related and financial impacts of DSDM rollout in sub-Saharan Africa, there is limited understanding of the factors facilitating DSDM adoption and successful implementation in Uganda, where specific contextual factors (e.g., erratic occupational mobility, health system decentralization) present unique challenges to the long-term feasibility and sustainability of these differentiated HIV care models.

In response, the present mixed-methods study seeks to characterize multilevel implementation determinants of, and opportunities for enhancing, DSDM adoption and reach. In Aim 1, we will examine the reach (or penetration) of DSDM implementation at population level, leveraging data from the Rakai Community Cohort Study. In Aim 2, we will characterize the implementation context and determinants of DSDM acceptability, adoption, appropriateness, and feasibility through in-depth interviews with people living with HIV enrolled in various DSDM and HIV clinicians implementing DSDM in rural Uganda. We will also borrow principles from human-centered design, including journey mapping, to document the interaction between patients, providers, and health systems throughout the DSDM implementation lifecycle.

The student will support the implementation of exciting mixed methods research, which seeks to document experiences delivering differentiated HIV care models in rural Uganda. The scope of work includes: developing and implementing training materials for in-country qualitative interviewers; drafting standard operating procedures for data collection/management; conducting semi-structured in-depth interviews with HIV clinicians and other facility-based health workers; synthesizing/analyzing textual data generated from interviews with people living with HIV and healthcare workers, including visualization of patient "journeys" through HIV care; and leading or contributing to research dissemination materials (e.g., scientific manuscripts, presentations to donors and implementation stakeholders). The student may also have an opportunity to contribute to quantitative analyses to estimating population coverage of community- and clinic-based differentiated HIV care models, leveraging data from a prospective HIV surveillance cohort in 40 communities.

the Rakai Health Sciences Program (RHSP), a collaborative biomedical research and service delivery organization founded in 1987. With offices in Entebbe and Kalisizo, RHSP commits to conducting innovative and relevant health research in infectious diseases, communicable and non-communicable diseases, and reproductive health to provide health-related services in order to improve public health and inform policy.

RHSP conducts extensive community epidemiologic and behavioral studies to document the
HIV/STI epidemics and risk factors, implements HIV/STI preventive services and undertakes
large community randomized intervention trials for HIV prevention, STI control, and prevention of adverse outcomes of pregnancy. RHSP leads the seminal Rakai Community Cohort Study, a prospective, population-based HIV surveillance study in 40 communities in the Rakai region. With funding from the U.S. Centers for Disease Control and Prevention through the U.S. President's Emergency Plan for AIDS Relief, RHSP has also overseen delivery of HIV care, treatment, and prevention at over 150 health facilities across 12 districts in southern Uganda.

The Social and Behavioral Sciences Department at RHSP leads cutting-edge, innovative ethnographic and qualitative research guiding HIV program prioritization and implementation, from early-stage formative research to endline program evaluations.

has demonstrated experience with qualitative research, including completion of graduate-level qualitative coursework; interest in implementation science and dissemination/implementation research; knowledge of or familiarity with HIV care and treatment programs, especially in sub-Saharan Africa; prior experience living and/or traveling in low- and middle-income countries, particularly rural areas of East and Southern Africa; and interest in team science and working with an interdisciplinary, international team of researchers, practitioners, and clinicians.

Name: Greg Rosen, Department of International Health, jrosen72@jhu.edu

I would describe my communication and mentorship styles as... 

(1) Direct and transparent
(2) Flexible and open
(3) Collaborative and supportive

A complementary student would have a working style and mentorship expectations that are..

(1) Self-stater, takes initiative, and problem-solves independently
(2) Proactive communicator
(3) Adaptable, with a good sense of humor
(4) Diligent and detail-oriented

In-country transportation costs: $50

Airfare and lodging/accommodations will be covered.