Newcomers and racialized people living with HIV (PLHIV) in Canada are faced with HIV stigma, social exclusion and access barriers to services. These challenges disrupt their engagement with the HIV care cascade. In response, the Ethno-racial Treatment Support Network (ETSN), a coalition of five HIV service organizations serving newcomers and racialized communities in Canada, developed a holistic treatment support program to address these barriers. The PLHIV-led program consists of three levels of skill building: Level One focuses on treatment literacy and health care access skills; Level Two focuses on peer support counselling skills; and Level 3 focuses on mentoring ETSN graduates to become facilitators of Levels One and Two training. The aim of this study is to evaluate the effectiveness of level one training for newcomer and racialized PHAs.
Based on consultation with program partners and community stakeholders, we used a mixed method approach to assess the effectiveness of ETSN Level One in increasing HIV treatment literacy and healthcare access skills among newcomer PLHIV. A pre- and post- training evaluation survey with validated scales was developed to capture the training effects in the domains of: (1) self-health management efficacy; (2) social support; (3) sense of empowerment; (4) community engagement; (5) HIV health literacy; and (6) treatment adherence. Since 2014, all ETSN graduates have completed the pre- and post- training surveys. In addition, qualitative data was collected at annual graduate reconnection sessions to document their post-training experiences. SPSS program 24.0 was used to analyze the quantitative data. Paired sample t-test and Cohen’s d’s effect size were used to evaluate training effect. Thematic analysis was applied to the qualitative data.
Sixty-two RPHA from African (51.6%), Caribbean (19.4%), East or Southeast Asian (14.5%), South Asian (4.8%) and Hispanic (9.7%) communities in Ontario, Canada completed the ETSN level One training survey between 2014 and 2017. Half of participants are female (50.0%) and majority of them are immigrants (93.5%), had a post-secondary degree (71.0%), and are on HIV medications (74.2%). Analysis revealed improvements between pre- and post- surveys in all domains with effect sizes midway between small and medium (d = 0.20-30), especially on domains of social support and treatment adherence. At 12-months post-training reconnection sessions, 60% of participants reported increased and sustained engagement with community service agencies and forming peer support networks through the ETSN training. Half of all Level One graduates continued onto level 2 training.
Comprehensive health promotion programs that combine treatment literacy, service advocacy and peer-driven support are effective in reducing health disparities among newcomer and racialized PLHIV. Collaboration with broader communities and service providers working with newcomer and racialized PLHIV may enhance awareness of the importance of treatment literacy and self-health management. Lessons learnt from ETSN are transferrable to other vulnerable PLHIV communities across Canada and internationally.