Understanding multilevel barriers and facilitators to HIV treatment among marginalized women living with HIV in the context of intersecting HIV, TB, and COVID-19 pandemics

项目总结/文摘

PROJECT SUMMARY/ABSTRACT Specific Aims: The overarching goal of this proposed study is to assess social and structural factors associated with antiretroviral therapy (ART) use and recent TB diagnosis among women living with HIV; and evaluate the potential impact of policies in controlling HIV. Specially, we aim to 1: Assess the associations between violence, economic, healthcare, and policy barriers and ART use among women living with HIV; 2. Characterize the associations between social, economic, healthcare, and policy barriers and recent TB diagnosis among women living with HIV; and 3. Estimate the potential impact of policy adoption of universal healthcare coverage for ART, non-discrimination protections, and gender-based violence protections on viral suppression, TB diagnosis, and deaths among women living with HIV. Significance: People living with HIV (PLHIV) are 19 times more likely to develop active TB, which is the leading cause of death in persons with HIV. Progress in combating HIV and TB has been made through integration of HIV/TB programs and efforts towards the UNAIDS goals for epidemic control. However, the emergence of COVID-19 and disruptions in prevention and treatment programs threaten efforts to control these pandemics. COVID-19 has also exacerbated gender inequities, because of economic pressures, violence, and stigmas affecting women. Structural barriers including discriminatory policies and poverty worsen the challenges faced by women and impede progress in controlling HIV and TB. In response, WHO and UNAIDS have prioritized the adoption of policies for universal healthcare coverage of ART, non-discrimination protections, and gender-based violence protections. Poor treatment adherence among women living with HIV contributes to TB progression and mortality; and complicates progress in epidemic control. This study aims to assess the role of social and structural factors affecting women living with HIV and provide direct and actionable evidence to inform policy changes and improve the health of women living with HIV. Approach: We will leverage data from 8646 women living with HIV in 8 countries in sub–Saharan Africa between 2020-2021 who participated in the PLHIV Stigma Index 2.0. We will use multilevel logistic regression models with random intercepts to assess factors associated with ART use (Aim 1) and factors associated with recent TB diagnosis (Aim 2). Lastly, for aim 3 we will utilize a Markov model to assess the potential impact of policy adoption on viral suppression, TB progression, and death among women living with HIV in Lesotho. Training information: Carrie Lyons’ training will consist of advanced methods specific to HIV and TB; advanced methods in social and behavioral epidemiology to appropriately incorporate contextual and structural level factors, and the use of multiple sources and types of data; and advanced methods in causal inference and methods for the analysis of observational data.