Linkage to HIV Care for Refugee Populations: Adapting Intervention Mapping Methodology to Design a Theory- and Evidence-Based Intervention in Nakivale Refugee Settlement in Rural Uganda

Abstract

Authors: Miranda Ravicz and Kelli N. O’Laughlin, MD Purpose: The world is facing an unprecedented crisis of forcibly displaced people (1). Refugees face unique health challenges, yet little is known about how to design effective health interventions in refugee settings. In Nakivale Refugee Settlement in southwestern Uganda, only 54% of people newly diagnosed with HIV will link to medical care (2). Linkage is lower than in other settings in sub-Saharan Africa, which suggests that interventions are needed to enhance engagement with HIV care among people accessing services in refugee settlements. We aimed to use the Intervention Mapping methodology to design a program aimed at increasing linkage to HIV care in Nakivale Refugee Settlement. Methods: Intervention Mapping is a framework for developing theory- and evidence-based health interventions, and includes six iterative steps: logic model of the problem; program outcomes and objectives; program design; program production; program implementation plan; and evaluation plan (3). A diverse group of stakeholders (N = 14), including community members and humanitarian actors, participated in a one-day interactive Intervention Mapping workshop in Nakivale which included small group break-out sessions and large group discussions. Results: Intervention Mapping provided an inclusive, efficient method for integrating community members and program implementers into the intervention planning process. Using Intervention Mapping, we developed a community-based chronic care program (C-3 Teams) to provide convenient, acceptable, integrated health services to clients with HIV, hypertension, and diabetes. The program would improve linkage to HIV care by integrating chronic care services at the community level to decrease stigma around receiving HIV therapy and to help clients overcome the barriers of distance to clinic. Conclusions: This work demonstrates that Intervention Mapping can be applied in a refugee settlement, and contributes to the body of literature on method-driven health intervention design and implementation for humanitarian crisis-affected populations.