Multiple-method assessment of the quality of health services targeting HIV high-risk groups in St Petersburg, Russian Federation

Background: Surveys with high-risk groups for HIV (female sex workers, drug users, men-who-have-sex-with-men) in St Petersburg have demonstrated low rates of health service utilization. This multi-component study assessed the aspects of quality services particularly relevant to high-risk groups – confidentiality and privacy, provider attitudes, and effective referrals – through complementary methodologies. Methods: A baseline study of quality of selected health services was implemented in St Petersburg, Russia, 2006, consisting of qualitative interviews with four city-level health administrators, facility audits at a purposive sample of health services (N=17), and probability-based surveys of health providers (N=222) and clients (N=220). Indicators were assessed through descriptive statistics. Main Findings: All four study components pointed to low levels of proactive referrals, particularly to social services, and a lack of available referral materials for both clients and providers. Health providers assessed privacy practices as low (31%), but high confidentiality (80%); conversely, only 54% of clients perceived confidentiality as high. Provider surveys revealed stigmatising attitudes towards high-risk individuals (e.g., only 45% agreed that HIV+ individuals in high-risk categories should receive free ARV treatment, as per Russian legislation). Qualitative interviews reflected stigmatising attitudes towards high-risk groups through the health system. However, providers rated high their need to increase skills in working with high-risk clients, and city-level officials recognized the importance of quality services for high-risk groups. Recommendations: Study findings are being used to improve Population Services International's (PSI) program in Russia and improve the quality of services provided to high-risk groups. Priority is allocated to training health providers in relevant areas, enhancing referral networks between health and social services, and working with city-level officials to institutionalise markers of quality services.