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Title: Intersectional Stigma Through the Care Continuum: A Mixed-Methods Study Integrating Theory and Method Lead Investigator: Alanna Bergman Faculty Mentor: Dr. Jason E. Farley

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.

Title: OWEL cancer education and awareness program (OCEAP) Lead Investigator: Joyline Chepkorir Faculty Mentor: Dr. Hae-Ra Han

Women living with HIV/AIDS (WLH) are at heightened risk for cervical cancer, and those 45+ years oldalso have elevated risk for breast cancer. Older Women Embracing Life (OWEL), a community advocacy organization, has formed the bedrock for social, emotional, spiritual, and mental support for WLH and their families in Baltimore city. Based on an initial stakeholder meeting, cervical and breast cancer literacy among WLH has been identified as a top priority as there is no program in place to focus on the health issues most salient to WLH. Cervical and breast cancers are preventable and can be detected early yet WLH, particularly Black women, bear a disproportionately higher burden of deaths from these cancers due, in large part, to limited cancer health literacy. To address this need, the purpose of this study is to develop and implement a cancer education and awareness program.

Hypothesis: The intervention will improve cancer literacy and decrease negative perceptions about breast and cervical cancer screening in Black WLH.

Title: AIDS Education and Training Center (AETC), Regional Partner for the MidAtlantic AETC Lead Investigator: Dr. Jason E. Farley

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.

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Title: Ending the HIV Epidemic (EHE) – Prevention Services Lead Investigator: Dr. Jason E. Farley

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.

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Title: Leveraging health to enable and adapt community health care worker strategies to improve TB/HIV patient outcomes in South Africa (LEAP-TB-SA) Lead Investigator: Dr. Jason E. Farley

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.

Title: Predicting HIV Viral Suppression Among People Treated for Multi-drug Resistant Tuberculosis Lead Investigator: Dr. Keri Geiger Faculty Mentor: Dr. Jason E. Farley

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.

Title: Evaluating the influence of risk perception and cultural worldviews on HPV vaccination intention among Haitian immigrant women living with HIV Lead Investigator: Dominique Guillaume Faculty Mentor: Dr. Kamila Alexander

Haitian immigrant women in the United States experience some of the highest cervical cancer and HIV incidence rates nationwide. Despite their high objective risk of cervical cancer, Haitian immigrant women living with HIV are less likely to undergo HPV vaccination. Risk perceptions have been identified as a critical component of health behaviors; and studies have reported that women living with HIV have low perceived risk towards cervical cancer. Low levels of risk perception may negatively influence decisions to engage in health promotion behaviors such as HPV vaccination. This exploratory mixed-methods study guided by the PEN-3 Model and the Theory of Planned Behavior evaluates how HIV status, cultural worldviews, and affective measures of risk perception influence HPV vaccination intention among Haitian immigrant women living with HIV and Haitian immigrant women without HIV.

Hypothesis: Affective measures of HPV and cervical cancer risk perception will be more predictive of HPV vaccination intention than individual-level factors.

Title: Understanding and predicting loss to follow-up from multidrug-resistant tuberculosis treatment in the setting of high HIV burden Lead Investigator: Katherine McNabb Faculty Mentor: Dr. Jason E. Farley

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.

Title: Continuation of COVID-19 vaccinations and infectious disease testing co-located with the Baltimore City health department’s syringe services program Lead Investigator: Dr. Omeid Heidari Faculty Mentor: Dr. Jason E. Farley

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.