Cultivating resilience and hope: A qualitative study of a pilot program using patient navigators to assist men who have sex with men with retention in the HIV care continuum in Uganda.

In Uganda, due to the criminalization of same-sex sexual practices, men who have sex with men (MSM) experience barriers to accessing HIV care. To retain patients within the HIV Care Continuum, some health interventions have used patient navigators as an ancillary support service. To understand the potential care benefits of using patient navigators for marginalized populations experiencing challenges to HIV care and treatment access in a Ugandan context, this qualitative study explored the experiences of newly diagnosed MSM using patient navigators for ARV retention in care in Kampala. Additionally, to gain insight into the feasibility of patient navigator interventions, this study also aimed to understand the perspectives and experiences of patient navigators working with HIV positive MSM. Individual in-depth, semi structured interviews were conducted with 24 HIV positive MSM and four patient navigators that were part of a patient navigator pilot program from January 2019 -December 2020. Analysis was done using manifest and latent qualitative content analysis. Results showed that HIV positive MSM in Uganda experienced a variety of social, emotional, and financial challenges that placed them at risk for dropping off the HIV Care Continuum. Patient navigators provided HIV positive MSM with the skills, support, and resources necessary to overcome these challenges. Based on study results, we conclude that within the patient navigator pilot program, patient navigators improved MSM participants' quality of life by helping them to achieve the HIV Care Continuum stages: diagnosis, linked to care, receiving HIV treatment, and retention in care. Study results suggest future research is needed on the psychosocial support needs of patient navigators, how the support needs of MSM change throughout their lifetime on the HIV Care Continuum, and how potential benefits of patient navigators may differ in rural Ugandan contexts.

Civil society demand for accountability to achieve the 90-90-90 targets: lessons from Eastern and Southern Africa.

PURPOSE OF REVIEW: Civil society demand for accountability has long been a critical component of the AIDS response. In the age of 90-90-90 HIV treatment goals, civil society advocacy has continued, but often in new forms. In particular, civil society accountability at the intersection of national policy and global health financing has taken on increasing importance, but has not been well documented. RECENT FINDINGS: Civil society demand for accountability is a key to addressing both the insufficient progress toward '90-90-90' HIV treatment goals and the gap in democracy in HIV policymaking particularly prevalent in the context of internationally financed HIV programming. Civil society can serve three vital functions for accountability: unlocking decision-making processes monopolized by powerful funders through North-South networks; challenging dominant ideas that justify status-quo policies; and 'venue shifting' to institutionalize new, more open spaces for policymaking. SUMMARY: The functions of civil society demand for accountability have played key roles in improving the AIDS response in several countries in East and Southern Africa. Dramatically scaling-up capacity for civil society advocacy is necessary in the near term to achieve global HIV goals.