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Current Projects

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
  • JustHouHS (Justice, Housing and Health Study)
  • Legal Levers for Housing Equity Research
  • Project Parivartan
  • Structures, Health and Risk among Reentrants, Probationers and Partners (SHARRPP)

Community-based Combination HIV Prevention in Tanzanian Women at Heightened Risk PI: Deanna Kerrigan

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.

2DR: Understanding the dynamics of dual regimen (2DR) ART in PLHIV PI: Deanna Kerrigan

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.

JustHouHS (Justice, Housing and Health Study) PI: Kim M. Blankenship

Funded jointly by NIMH and NIAID, JustHouHS examines the intersecting impacts of mass incarceration, housing instability, housing policies and HIV related risks and race inequities in those risks. Aim 1 of the project involves analysis of the variation across the US in the degree of restrictiveness of subsidized housing policies as it relates to rates of HIV/AIDS and STIs, as well as race inequities in those rates. Aim 2 focuses on understanding from the perspective of vulnerable populations how mass incarceration—including history of criminal justice involvement (personal, family, and sexual partner) and exposure to ‘hyperpolicing”—housing stability, and experiences with subsidized housing policies intersect to impact HIV/AIDS/STI related sexual risks, and potentially produce race disparities in these risks. For this, we are collecting longitudinal qualitative and quantitative data from low income residents of New Haven, CT, half of whom have a recent history of incarceration. Aim 3 involves analysis, from the perspective of various stakeholders, including policymakers, program implementers, landlords, criminal justice personnel, and housing and legal service providers, of how subsidized housing policies are interpreted and implemented locally and why they are interpreted and implemented in this way. For this, we are conducting and analyzing semi-structured stakeholder interviews.

Project Parivartan PI: Kim M. Blankenship

Project Parivartan, which means "long-term change," as well as "metamorphosis," is a study of the implementation and impact of structural interventions (with a focus on community mobilization) for HIV prevention among female sex workers in Andhra Pradesh (Rajahmundry, East Godavari district). Specifically, the project aims to understand the context of HIV risk among female sex workers and how community mobilization interventions address that risk. Data were collected through surveys (serial cross-sectional) and ethnographic methods (life history interviews, key informant interviews, field observation, etc. The Parivartan team included staff in India and the US at several academic institutions. Although data collection has concluded, de-identified data are available and we accept requests via a concept sheet process, proposing new ideas for collaborative analysis.

SHARRPP (Structures, Health and Risk among Reentrants, Probationers and Partners PI: Kim M. Blankenship

Funded by the National Institute on Drug Abuse (NIDA), the purpose of the SHARRPP study (Structures, Health and Risk among Reentrants, Probationers and Partners) was to analyze the interconnections between the coercive mobility produced by US drug policies (the massive migration between the criminal justice system and the community) and race disparities in HIV-related sexual risk, among a sample of non-violent drug offenders in Connecticut. Further, the study examines whether the association between coercive mobility and HIV-related sexual risk is affected by the degree of social disorganization in the communities in which these re-entrants reside. It also analyzed the feasibility of recruiting and following the sexual partners of these individuals in order to better understand the impacts of coercive mobility on the partners' HIV-related risk. Longitudinal data (over 3 years) was collected in New Haven, CT via surveys and semi-structured interviews and combined with secondary data related to neighborhoods. Data collection has ended, but de-identified data are available and we accept requests via a concept sheet process, proposing new ideas for collaborative analysis.