The stigma and discrimination related to human immunodeficiency virus (HIV) have been obstacles against the achievement of the global health priority targets by negatively impacting adherence to, and uptake of services. As an effort to improve the practice and service in HIV and related areas, this project sought to develop an evidence-informed guideline to reduce HIV-related stigma and discrimination.
Aims: The overall aim of this project was to develop an evidence-informed guideline to reduce HIV-related stigma and discrimination among healthcare workers in the Ethiopian context.
Method
First, I conducted a systematic literature search for guidelines and systematic reviews, followed by systematic review of primary studies. After appraising the evidence found through the literature search, a content analysis of the included units of evidences was carried out to generate a list of working recommendations. Summaries of Findings tables were produced using software package developed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group. The feasibility and appropriateness of the recommendations were then assessed using the Guideline Implementability Appraisal (GLIA v.2) checklist. Consensus was established through two rounds of a Delphi panel survey and two consensus meetings. The recommendations were also evaluated by external reviewers. In the final phase of this project, barriers and facilitators to the implementation of the guideline were assessed through key informant interviews with health professionals and health managers.
Results
Through the systematic literature search for guidelines, best practices, tools and systematic reviews I included 12 records (six guideline-related tools, and six systematic reviews). Since adequate conclusive evidence could not be drawn from these resources,a systematic review of quantitative evidence was undertaken. Initially, 31 recommendations and good practice points were extracted and drafted from the content analysis of the documents included. The recommendations were evaluated using a Delphi panel and external experts. Based on these evaluations, 12 recommendations and three good practice points were retained in the final draft. To contextualize the recommendations, barriers and facilitators were further explored using key informant interviews. The key informants suggested that the guideline should be introduced through training, workshops, hard copies, multidisciplinary team (MDT) meeting of experts working on care and treatment of clients living with HIV and HIV mentorship program and through one-to-five networks in healthcare facilities. It was also suggested that the indicators should be integrated into local hospital key performance indicators (KPI). The importance of identifying and establishing the implementation structure, implementation team and a focal person responsible for overseeing the implementation of the guideline was stressed. Key informants specifically reported that the guideline would help to achieve not only HIV-related goals, but also other health facility initiatives such as ‘compassionate,respectful, and caring’ (CRC) services and clean and safe health facility (CASH)initiatives.
Conclusion
The project sought to develop trustworthy and rigorous guideline that is applicable and can be integrated into current initiatives and practices in the Ethiopian context. The current guideline can be implemented into new and existing health facility initiatives (such as CRC and CASH) and included in platforms like mentorship, multidisciplinary team (MDT) meetings and one-to-five networks. To ensure uptake of this guideline, health managers need to identify the implementation structure, implementation team and a focal person to implement the guideline.Thesis (Ph.D.) -- University of Adelaide, The Joanna Briggs Institute, 201
