Title

Quality of care for key populations at public health facilities in South Africa: findings from Ritshidze’s Community-Led Monitoring

Presenter

Elise Lankiewicz

Authors

J. Oladipo¹, L. Sono¹, M. Manzi¹, P. Sibanyoni¹, P. Twala², J. Sherwood³, L. Rutter⁴, E. Lankiewicz³

Institutions

¹Ritshidze Community-Led Monitoring Programme, Johannesburg, South Africa, ²Treatment Action Campaign, Johannesburg, South Africa, ³amfAR, The Foundation for AIDS Research, Washington, DC, United States, ⁴Health GAP, Johannesburg, South Africa

BACKGROUND: High quality of care, including safe and respectful care, is vital to retention in HIV services. Key populations (KPs) most at risk of HIV, like gay, bisexual, and other men who have sex with men (GBMSM), people who use drugs (PWUD), sex workers (SW), and transgender people (TG), face increased barriers to quality care and often face discrimination at health facilities, though few data exist on these indicators for KPs in South Africa. Better understanding gaps in quality service provision may allow for more targeted interventions to improve KP care.
METHODS: The Ritshidze Community-led Monitoring Programme recruited KPs to participate in a cross-sectional survey in 7 provinces from July to September 2022 using a community-based snowball sampling method. Descriptive analysis was used to assess KP experiences at public health facilities. Multivariable logistic regression models (significance level of p<0.05) adjusted for age and province were used to assess the relationship between KP identity and being denied services.
RESULTS: 5,060 KPs (55%) indicated they access services at public health facilities and were included in the analysis. Overall, 14% (n=686) of KPs felt very safe and 13% (n=636) felt very comfortable using public health clinics. Feelings of safety and comfortability were highest among SW (20% and 20%) and lowest among PWUD (11% and 9% respectively). Across KP groups, 14% (n=641) report service denials based on KP status. Service denials were highest among PWUD (20%, 388), then SW (13%, n=137), TG (10%, n=48), and GBMSM (6%, n=68). As compared to GBMSM, all other KP groups were significantly more likely to be denied services because of their KP status (PWUD: aOR=4.41 95% CI[3.34,5.82]; SW: aOR=2.66, 95% CI[1.94,3.63]; TG: aOR=2.08, 95% CI[1.4,3.09]).
CONCLUSIONS: KPs are being denied services at public health facilities and report low levels of comfortability and security/safety accessing care. Further work is needed to ensure that staff at public health facilities are equipped to provide high-quality care to KPs, with particular remediation needed to improve experiences for PWUD.

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