Mixed methods pilot evaluation of a gender-sensitivity training for HIV care providers in Uganda: Effects on providers and clients

In sub-Saharan Africa, gender norms shape women's and men's barriers to HIV care engagement, and influence providers' behaviors. Interventions are needed to build providers' capacity for delivering gender-sensitive HIV care. We pilot tested a gender-sensitivity training for HIV care providers and staff in Uganda. Using a quasi-experimental controlled trial (2022-23), we assessed a 4-session intervention, developed by the study team, focused on: gender norms; skills to address HIV care barriers, stigma, and gender-based violence; gender bias recognition/reduction; and client-centered communication. Six clinics were matched (e.g., size, services) and randomly allocated to training intervention or standard-of-care. We enrolled 144 HIV care providers (61 intervention, 83 control) and a cohort of 238 clients with HIV, newly initiated on ART or struggling with adherence (119 per arm). Participants completed structured questionnaires at baseline, 6- and 12-months, and training providers participated in an exit focus group or interview (n = 53). We tested intervention effects using generalized linear models and thematically analyzed qualitative data. Intervention providers reported increased gender-sensitive care competence compared to the control group (Wald χ² = 20.94, p < 0.001), supported by qualitative reports of greater gender-related knowledge, perceived importance of gender-sensitive care, and skill development. They also reported increased empathy towards clients (B = 0.17, 95% CI = 0.00-0.33, p = 0.04) and use of stress regulation techniques (B = 0.42, 95% CI = 0.13-0.72, p = 0.005). Qualitative data indicated positive effects on client-centered practices (e.g., rapport-building, empathy, eliciting client agendas) and reduced gender bias. No treatment effects were observed in ART adherence or perceived care quality, but clients at intervention clinics reported greater stigma reduction (Wald χ² = 18.72, p < 0.001). This study suggests gender-sensitivity training may improve provider practice and reduce stigma, supporting further testing.