Cisgender Black women face consistent disparities in Human Immunodeficiency Virus (HIV) and sexually transmitted infections (STIs) as a result of implicit bias, racism, sexism, and structural barriers. In the United States (U.S.), cisgender Black women accounted for 19% of new HIV infections in 2019, and 55% of new HIV infections among all women despite only being 13% of the U.S. female population. Those same barriers continue to perpetuate inequities in sexual health by limiting access to sexual services and uptake of highly effective HIV/STI prevention options. Improving the sexual health of Black women is a public health issue of high importance due to the potential negative impact STIs and HIV have on health systems and the social, sexual, and reproductive health of Black women. To address this public health need, this study aims to advance access of sexual health services to cisgender Black women for HIV and STI prevention using a framework that engages the participants in personal sexual health options delivered through telemedicine.
Hypothsis: This telemedicine intervention will improve HIV/STI risk perception, increase engagement with STI/HIV screening, and make sexual health and HIV prevention a shared value among cisgender Black women living in Maryland.
South Africa has a high burden of persons co-infected with multi-drug resistant tuberculosis (MDR-TB) and human immunodeficiency virus (HIV). MDR-TB/HIV co-infection is difficult to treat due to drug-drug interactions which lead to antiretroviral treatment (ART) substitutions, overlapping side-effect profiles, and high pill burden. While worldwide only about 55% of MDR-TB patients are successfully treated, South Africa has shown a recent improvement in MDR-TB treatment outcomes. Although many patients with MDR-TB/HIV co-infection will be cured of MDR-TB, they must continue on daily ART for the rest of their lives. Data suggest that some patients who successfully complete MDR-TB treatment fail to achieve HIV viral suppression by the time they complete MDR-TB treatment. As new TB treatment options are introduced and more people survive MDR-TB, understanding the effects of MDR-TB treatment on HIV viral suppression will only increase in importance.
The purpose of this study is to investigate predictors of HIV viral suppression among people living with HIV/AIDS (PLWHA) who have successfully completed MDR-TB treatment.
Description: The Coronavirus 2019 (COVID-19) pandemic has led to widespread disruptions in healthcare utilization in the United States, including increases in forgone care, and has disproportionately impacted vulnerable and minority communities. The purpose of this study is to further understand the prevalence and predictors of forgone care in Baltimore, MD using a population representative sampling strategy with oversampling of populations currently underrepresented in the current COVID-19 forgone healthcare literature. The knowledge gained from this study will be critical to better understanding how the social determinants of health intersect with healthcare utilization during large-scale public health emergencies and will help inform efforts to improve health system resilience for future health threats.
Hypotheses: H1: African American and Latinx people will have a higher prevalence odds ratio (POR) for forgone healthcare after controlling for health insurance status; H2: Impoverished people, regardless of race/ethnicity, will have a higher POR for forgone healthcare.
This project involves collaboration of the Center for Infectious Disease, Baltimore City Health Department and the Syringe Support Services (SSP) van by collaborating to provide access to vaccines, HIV, HCV and STI testing and needle exchange services in the community.
This portfolio of work seeks to optimize treatment opportunities by integrating DR-TB and HIV treatment into primary care settings, where nurses provide the vast majority of care in South Africa.
The World Health Organization estimates that 16% of all multi-drug resistant tuberculosis (MDR-TB) patients are lost to follow up (LTFU), placing them at increased risk for the development of additional resistance to antituberculosis medications and early death. Despite mounting knowledge about the risk factors for LTFU from MDR-TB treatment and the End TB Strategy directive that patients at-risk for suboptimal treatment success be given priority attention, there is currently no evidence-based method that allows for the early identification of patients at-risk for being lost from care. This study will develop a model for predicting LTFU from MDR-TB treatment that can ultimately be used to guide MDR-TB providers in identifying patients at high-risk for LTFU and prioritizing their receipt of support services that promote care engagement and retention.
Primary Aim: To develop a prediction model for LTFU from MDR-TB care based on the patient characteristics available at treatment initiation utilizing LASSO regression and k-fold cross-validation.
Adherence to HIV and tuberculosis (TB) treatment is the most effective means to improve patient outcomes. Stigma, which undermines adherence and reinforces healthcare inequities, remains a major barrier to achieving TB eradication and HIV prevention goals. Despite this, we know little about if and how stigma changes over time, or in response to hallmark events in infectious disease treatment. As individuals move from pre-diagnosis to diagnosis of one or more infectious diseases, and towards TB cure and/or HIV viral suppression, they move in and out of illness identities. This research will use mixed-methods to explore stigma through the TB/HIV care continuum to determine if individuals experience higher levels of stigma at specified time points, and whether illness identity, mediated by the hallmark events of HIV viral suppression as well as TB smear and/or culture conversion, impact a person’s stigma score.
A nested prospective cohort within LEAP-TB-SA will undergo serial stigma measurements to determine if mean level of stigma changes through the care continuum. This data will be triangulated against serial qualitative interviews to highlight if and how stigma changes over time and across hallmark events.
Mycobacterium tuberculosis (TB) is the leading cause of death for persons living with HIV (PLWH) in South Africa (SA). Estimates suggest that if factoring in immediate lost to follow-up, a mere 52% of TB/HIV co-infected individuals have successful treatment outcomes.
mHealth solutions designed to support affordable human resources for health, such as community health workers (CHWs), offer the opportunity to reimagine a patient-centered, system-level solution that may radically change care models in low resource settings. The ‘leap’ of mHealth is most potent and practical in settings where desktop-based infrastructure is lacking, and hard-wired internet connectivity is unavailable. This study combines individual cascade steps through TB and HIV smartphone and tablet-based mHealth applications implemented by a CHW with an innovative TB/HIV cascade intervention.
Hypothesis: The intervention will have fewer composite negative TB outcomes (i.e. treatment failure, loss to follow-up, and death) compared to attention controls.
This COVID study is funded by the COVID-19 Prevention Network (CoVPN) of the National Institute of Allergy and Infectious Diseases. This surveillance study seeks to estimate the number of people who have or have had the SARS-CoV-2 virus using venue-time sampling approaches.
This is a randomized comparative effectiveness trial where households will be randomized to determine the optimal SARS-CoV-2 (COVID-19) testing modality in a population-representative sample of households in Baltimore City, Maryland. 1,386 households in Baltimore City will be randomized 1:1:1 to one of three testing modalities: 1) fixed-site standard of care testing; 2) community-based mobile van testing; or 3) self-collected home, based testing.
The target population will include English- and Spanish-speaking families residing in Baltimore City households (N=238,427). The sample size goal is 1,386 households (0.44% of households) or 3,000 individual household members.
Ending the HIV Epidemic (EHE) Prevention Services Program collaborates with surrounding community clinics, the needle exchange program, housing venues, and other community support partners to reduce the spread of HIV and increase access to PrEP as well as linking individuals who test positive for HIV treatment.
This program is a 5-year Ryan White Special Early Intervention Services funded project in collaboration with the Baltimore City Health Department HIV / STD Prevention Program to reduce the number of new HIV infections. Our community health workers provide HIV, HCV and STI testing (via community outreach or home-based options), linkage to HIV / STI prevention and treatment services including PrEP and PEP via standard of care in clinics, mobile sites, or telehealth visits.
The JHU MidAtlantic AIDS Education and Training Center is a Regional Partner with the University of Pittsburgh. We provide education, training, capacity building, clinical consultation, preceptorships and technical assistance on HIV and other comorbidities to health providers of Federally Qualified Health Centers, primary care sites, community health centers, medication assisted treatment centers, behavioral health centers, rural health centers, and Historically Black Colleges and Universities in the state of Maryland.
The JHU AETC trains health professionals from various backgrounds and locations throughout the region. Training is tailored to meet the HIV prevention, care, and treatment challenges of specific geographic areas, clinics, and individual clinicians. The training center works diligently to prepare providers with skills and knowledge that is tailored to the populations they serve. This individualized focus is a key element of the AETC’s success.
Our training and education are based on the unique needs of trainees, and provides the foundation for workshops, seminars, symposia, mini-residencies, teleconferences, and other training sessions that prepare providers and clinicians to provide effective HIV prevention, care, and treatment.