Current projects of the Center on Health, Society, and Risk include:
- Community-based Combination HIV Prevention in Tanzanian Women at Heightened Risk
- Stigma, Social Cohesion and HIV Outcomes among Vulnerable Women across Epidemic Settings
- Atlas: Understanding the dynamics of switching to long-acting, injectable ART from fixed dose oral combination therapies among PLHIV in the U.S., Spain, and Argentina
- 2DR: Understanding the dynamics of dual regimen (2DR) ART in PLHIV
- Inequality, Social Justice and Health Lab
Project Shikamana which means “stick together” is a community-based combination HIV prevention intervention for Tanzanian women at heightened risk. This NIMH funded two arm community randomized controlled project was conducted in two matched, distinct communities in Iringa, Tanzania. Survey data and blood samples were collected at baseline and 18-month follow up on 203 HIV+ and 293 HIV- women. Qualitative interviews were conducted among participants as well as key stakeholders including clinical providers, police, venue owners etc. The community driven and designed intervention reflects both the principles of community empowerment as well as local need and context. Core components of the Project Shikamana community empowerment intervention include a Drop-in-Center where women can receive HIV tests and condoms and can participate in programming on HIV and STI prevention, ART adherence, financial literacy and financial planning, family planning and reproductive health; violence prevention; peer navigation and venue-based peer led education; provider sensitivity training, and SMS text reminders about all components. These activities led to the formation of a community savings group and community funded education and outreach activities. Data collection was completed in January of 2018 and is now being analyzed. There are opportunities for secondary data analysis and other projects built on our established research infrastructure in Tanzania.
Stigma, social cohesion & HIV outcomes among vulnerable women across epidemic settingsPI: Deanna Kerrigan
This 5-year National Institute of Mental Health (NIMH) study is a longitudinal assessment of the role of HIV and sex work stigma and social cohesion as key social determinants of HIV outcomes among female sex workers (FSW) living with HIV. The study is being conducted in two distinct social and epidemic settings, Tanzania and the Dominican Republic, and will assess the impact of HIV and sex work stigma on access to treatment and adherence to antiretroviral treatment (ART) as well as the potential role of social cohesion as a mediating factor of HIV and sex work stigma. A primary aim of this research is to develop a valid and reliable aggregate measure of sex work-related stigma tailored to the realities of FSW living with HIV in distinct social and epidemic contexts. In past research, significant attention has been paid to the measurement of HIV stigma while much less emphasis has been placed on other intersecting social stigmas, including the measurement of sex work stigma. Approximately 400 women (200 in Tanzania and 200 in the Dominican Republic) will be followed through 3 rounds of annual data collection. At each round of data collection, participants will be surveyed and will provide blood samples to assess the presence of ART in the blood as well as viral suppression. Purposively selected participants will participate in in-depth and cognitive interviews to inform measurement development and to explore the dynamic social context of HIV and sex work stigma and social cohesion. Findings will offer guidance to tailored treatment as prevention interventions among FSW across geographic and epidemic settings. Data collection is ongoing.
Atlas: Understanding the dynamics of switching to long-acting, injectable ART from fixed dose oral combination therapies among PLHIV in the US, Spain, and ArgentinaPI: Deanna Kerrigan
In this qualitive study, our team is using semi-structured, in-depth interviews (IDIs), to explore patient and provider perceptions and experiences of Long Acting Injectable (LAI) antiretroviral treatment (ART). LAI ART may improve HIV treatment adherence and patient outcomes providing a potentially beneficial future HIV treatment modality option to people living with HIV (PLHIV). While ongoing clinical trials will examine the safety and efficacy of an injectable regimen of ART, limited information exists on patient and provider experiences transitioning from prior long-term daily oral ART regimens to new treatment modalities such as LAI, which is critical to informing potential future roll-out into clinical care. Up to 20 PLHIV and 5 providers will be interviewed in Spain, Argentina and in multiple cities across the United States for a total of up to 75 IDIs. Participants will include a balance of men and women and reflect the diversity of PLHIV in terms of other socio-demographic (age, sexual orientation, socio-economic status) and behavioral characteristics (drug use, prior injectable contraception, etc.) as study sites allow. Study findings will inform potential roll-out of LAI ART including informing appropriate candidates for making the transition to this treatment modality from current treatment regimens and strengthening clinical care support systems to ensure optimal health outcomes sensitive to the specific implications of LAI for individuals who have been engaged in long-term ongoing treatment. Data collection is ongoing.
In this qualitative study, our team is interviewing people living with HIV (PLHIV) in multiple settings where prior or ongoing use of dual regimen ART exists about their transition to and experiences with dual regimen (2DR) antiretroviral therapy (ART). Dual regimen ART has the potential to reduce patient toxicity, significantly reduce health care costs and increase future regimen options to PLHIV. While ongoing clinical trials are evaluating the non-inferiority of such ART regimens on patient outcomes including viral suppression, resistance, and levels of treatment failure, limited information exists on patient and provider experiences with these regimens to inform potential future roll-out into clinical care. In this ViiV healthcare funded study, patients and providers across the United States as well as in Spain and Argentina will be interviewed about their perceptions and experiences of dual regimen ART. Using semi-structured, in-depth interviews (IDIs), approximately 20 PLHIV and up to 5 providers will be interviewed in each country for a total of up to 75 IDIs. Participants will include a balance of men and women and reflect the diversity of PLHIV in terms of socio-demographic (age, sexual orientation, socio-economic status) and behavioral characteristics (illicit drug use, etc.). Study findings will inform potential roll-out of dual regimen ART including informing appropriate candidates for this approach and strengthening clinical care support systems to ensure optimal outcomes for this regimen. Data collection is ongoing.