Presented by Katherine Andrinopoulos at a July 2016 brown bag lunch.

1. Defining Quality of HIV
Services for MSM and
Transgender Women:
Results of a systematic review
Katherine Andrinopoulos, PhD
MEASURE Evaluation
Tulane University School of Public Health
and Tropical Medicine
July 12, 2016
Acting on the Roadmap for Health Measurem
and Accountability
USAID BROWNBAG PRESENTATION

2. Global, five-year, $180M cooperative agreement
Strategic objective:
To strengthen health information systems – the
capacity to gather, interpret, and use data – so
countries can make better decisions and sustain good
health outcomes over time.
Project overview

3. Improved country capacity to manage health
information systems, resources, and staff
Strengthened collection, analysis, and use of
routine health data
Methods, tools, and approaches improved and
applied to address health information challenges and
gaps
Increased capacity for rigorous evaluation
Phase IV Results Framework

4. Global footprint—32 countries (2016)

5. • Men who have sex with men (MSM) and
transgender women are key populations
disproportionately affected by HIV
• Provision of quality HIV services is necessary
to reach the 90-90-90 targets
• Stigma, discrimination, and other unique
factors affecting MSM and transgender
women’s service use warrant special
consideration in the conceptualization of
quality
Activity rationale

6. Evolution of quality concepts

7. • To establish a definition of quality for HIV services for
MSM and transgender women
• To develop an analytical framework for quality to include
appropriate domains and levels for measuring quality
Activity purpose

8. • Literature review
• Searched PubMed, relevant websites
• Inclusion criteria: Published after 2000;
focused on quality healthcare for MSM &
transgender women
• Search terms were related to quality, HIV,
MSM, and transgender populations
• Expert review via two webinars
Methods

9. Literature review

10. Literature review analysis
• Coded documents
using NVivo software
• Codes developed from
seminal frameworks on
quality & HIV guidance
documents
• Examined differences in
concepts across MSM
& transgender women

11. Document availability
Focus population
N=137 documents identified
43%
15%
42%
MSM Transgender Both

12. Document availability
Service delivery venue
53%
38%
9%
1%
Facility Multiple Community Home
N=137 documents identified

13. Document availability
Geographic location
66%
32%
5% 4%
15%
NA/Eur/Aus Africa LAC Asia Global
N=137 documents identified

14. • From an emphasis on providers to a multi-level
systems perspective on how to design and
monitor programs using quality benchmarks
• From an emphasis on stigma and
discrimination to one that also gives equal
weight to technical and cultural competency
Shifting the quality paradigm

15. Quality HIV services for MSM and
transgender women are those that are:
• Based on scientific evidence
• Culturally and technically competent
• Delivered through efficient and effective linkages across
a variety of service delivery models to ensure continuity
of care
• Voluntary, confidential, and timely
• Delivered in a stigma-free environment by providers
capable of addressing a number of MSM and trans
health needs
Definition of quality

16. Analytical framework

17. Technical competency
• Understand the difference between sexual orientation and gender
identity, use correct terminology and communicate with clients in a
way that builds trust and rapport
• Possess the skills to appropriately deliver HIV and ancillary services
to make effective referrals and track them
• Ensure the consent and confidentiality of services
Cultural competency
• Be familiar with the culture of MSM and transgender populations as
affects healthcare (age, past experiences of healthcare discrimination,
etc.)
• Be able to include same-sex spouses in care
Stigma-free
• Deliver services in a non-judgmental manner without discrimination
Provider level

18. Technical competency
• Develop and enforce appropriate protocols following national
and global standards
• Maintain the necessary commodities and equipment
• Provide supportive supervision for providers
• Establish networks for referrals and mechanisms for tracking
them
Cultural competency
• Be responsive to preferred time a places for service provision
• Provide gender neutral bathrooms
• Adopt policies that recognize same-sex partners of clients
Stigma-free
• Develop and post non-discrimination policies publicly
• Monitor waiting rooms for discrimination; sensitize reception
and security personnel
Organization level

19. Technical competency
• Promote special credentialing for providers related to MSM and
transgender healthcare
• Support effective linkages across service delivery models and types
of services
Cultural competency
• Ensure variety in the manner by which HIV services are delivered
appropriate for the context, and to cater to different clients’ needs
Stigma-free
• Include sexual orientation and gender identity in non-
policies tied to appropriate follow-up and sanctioning
• Engage MSM and transgender women in the design and delivery
of HIV services, and as members of HIV governing bodies
Health system

20. • Support a multi-level systems perspective to
achieving quality in service provision
• Move towards the adoption of measures for
the three quality domains
• Track elements of quality at each level
Recommendations

21. Available at
www.measureevaluation.org
Defining Quality of HIV Services
for MSM and Transgender Women

22. This presentation was produced with the support of the United States Agency for
International Development (USAID) under the terms of MEASURE Evaluation
cooperative agreement AID-OAA-L-14-00004. MEASURE Evaluation is
implemented by the Carolina Population Center, University of North Carolina at
Chapel Hill in partnership with ICF International; John Snow, Inc.; Management
Sciences for Health; Palladium; and Tulane University. Views expressed are not
necessarily those of USAID or the United States government .
www.measureevaluation.org