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. 2024 Jan-Feb;35(1):27-39.
doi: 10.1097/JNC.0000000000000443. Epub 2023 Nov 29.

"I Have to Do It in Secrecy": Provider Perspectives on HIV Service Delivery and Quality of Care for Key Populations in Zambia

Drosin M Mulenga  1 , Joseph G Rosen, Lunda Banda, Maurice Musheke, Michael T Mbizvo, Henry F Raymond, Ryan Keating, Harold Witola, Lyson Phiri, Scott Geibel, Waimar Tun, Nanlesta Pilgrim
Affiliations

"I Have to Do It in Secrecy": Provider Perspectives on HIV Service Delivery and Quality of Care for Key Populations in Zambia

Drosin M Mulenga et al. J Assoc Nurses AIDS Care. 2024 Jan-Feb.

Abstract

Key populations (KPs) experience suboptimal outcomes along the HIV care and prevention continua, but there is limited study of the challenges service providers encounter delivering HIV services to KPs, particularly in settings like Zambia, where provision of these services remains legally ambiguous. Seventy-seven providers completed in-depth interviews exploring constraints to HIV service delivery for KPs and recommendations for improving access and care quality. Thematic analysis identified salient challenges and opportunities to service delivery and quality of care for KPs, spanning interpersonal, institutional, and structural domains. Limited provider training in KP-specific needs was perceived to influence KP disclosure patterns in clinical settings, impeding service quality. The criminalization of KP sexual and drug use behaviors, coupled with perceived institutional and legal ambiguities to providing HIV services to KPs, cultivated unwelcoming service delivery environments for KPs. Findings elucidate opportunities for improving HIV service delivery/quality, from decentralized care to expanded legal protections for KPs and service providers.

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Conflict of interest statement

N. Pilgrim is currently employed by ViiV Healthcare. ViiV Healthcare neither funded nor had any involvement in the present study. The remaining authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Map of study implementation districts (shaded in blue) in Zambia, by province.
See this image and copyright information in PMC

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