160186 Multiple-method assessment of the quality of health services targeting HIV high-risk groups in St Petersburg, Russian Federation

Tuesday, November 6, 2007: 9:10 PM

Varja Lipovsek, PhD , Regional Researcher, Population Services International, Bristol, United Kingdom
Tatiana Kazantseva, MA , Program Manager, Russia, Moscow Office, Population Services International, Moscow, Russia
Elena Arutyunova, MA , Director for Behavior Change Communications, Russia, Population Services International, Moscow, Russia
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.

Learning Objectives:
1) List the components of quality of health services which are essential to providing appropriate services to high-risk groups, in context of St Petersburg, Russia 2) Describe the main problems found with providing quality services, at the level of health facilities and health providers, in St Petersburg, Russia 3) Articulate programmatic and policy recommendations for improving quality of health services for high-risk groups

Keywords: Health Care Delivery, HIV Risk Behavior

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.