Exploring factors associated with primary healthcare providers' attitudes towards HIV services provision in Georgia.

BACKGROUND: Primary health care (PHC) providers play a key role in delivering essential care to people living with HIV (PLWH). In Georgia, as in the Eastern European and Central Asian (EECA) region, the HIV epidemic is associated with rising life expectancy and increasing chronic disease comorbidity among PLWH due to improved access to antiretroviral therapy (ART). These evolving dynamics call for a more inclusive approach to HIV care, addressing the diverse needs of those affected. Strengthening the capacity of PHC providers to deliver integrated care can enhance healthcare systems' responses to the epidemic and improve outcomes for PLWH in Georgia. METHODS: This cross-sectional study assessed HIV-related knowledge, attitudes and practices and their association with the attitude towards HIV service provision among PHC providers in Georgia. Data were collected through structured interviews with PHC providers from various regions. Bivariate and multivariable ordinal logistic regression analysis were conducted. RESULTS: The study included 256 participants with an average age of 55.4 years (SD = 10.3), predominantly female (96.1%), and from regions outside Tbilisi (94.5%). Majority of the participants demonstrated a lack of correct knowledge about HIV (82.0%) and ART (86.3%), almost 30% exhibited discriminatory belief regarding PLWH separation and more than half perceived health care providers to be at risk of acquiring HIV infection when caring for PLWH (55.1%). While 75.4% agreed or strongly agreed that PHC providers should provide care for HIV patients, 77.0% expressed willingness or strong willingness to do so. In the multivariable regression analysis, being located outside Tbilisi was associated with higher odds of a positive attitude towards HIV service provision (aOR = 6.22, 95% CI: 1.99-19.50). In contrast, respondents who were unsure or disagreed with the need to separate HIV-positive clients from those of unknown HIV status had significantly lower odds of a positive attitude towards HIV care provision (aOR = 0.14, 95% CI: 0.06-0.31 and aOR = 0.43, 95% CI: 0.22-0.86, respectively) compared to those who had such discriminatory belief. CONCLUSION: This study identified geographic location, discriminatory beliefs, and misperceptions about HIV transmission risk as key factors associated with PHC providers' attitudes towards HIV service provision. Addressing these through evidence-based interventions can foster more inclusive, effective HIV care in Georgia, supporting national targets and global best practices.