# Exploring barriers and facilitators to women who use drugs (WWUD) awareness, acceptance and uptake of COVID-19 testing, the CARE study.

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2021 · $654,592

## Abstract

Project Summary
 In the U.S. women who use illicit drugs (WWUD) have disproportionately high rates of infectious
(e.g., HIV, HCV), chronic, and pulmonary diseases that elevate their risk for COVID-19. Their health and
disease profile is driven by enduring social conditions (e.g., scarcity of income, food insecurity, access to
health services, housing, discrimination). These prevailing social conditions can also undermine WWUDs’
ability to protect themselves from COVID-19 (e.g., washing hands, social distancing). Drug procurement
and use, which are largely social processes, further challenge these self-protection measures. Testing
and future vaccination is vital to reducing COVID-19 among this high-risk population, necessitating
accessible testing schemes. We propose a mixed methods study that draws upon the Andersen
Behavioral Model10 and is grounded in eco-social theory. Specifically, the Baltimore-based study aims to:
1) explore predisposing social factors (e.g., housing, food security), individual-level factors (e.g., drug use,
mental health), and beliefs (e.g., medical mistrust) that are facilitators and barriers of COVID-19 testing
and perceived risks (e.g., income generation, violence) resulting from a diagnosis through in-depth
interviews among WWUD (N=15) and a cultural domain analysis (N=45); 2) gain an understanding of the
enabling community-level environment (e.g., medical and social service agencies that currently serve
WWUD, existing city-wide COVID-19 testing sites) that could facilitate or hinder WWUDs’ COVID-testing
uptake through observations (N=8-10) and key informant interviews (N=10); and examine predisposing
social factors, individual-level factors, and beliefs that are associated with COVID-19 testing and retesting
among a cohort (N=250) of WWUD at baseline and 3-month follow-up. Optional testing offered at both
study visits will be a self-administered, rapid antigen test. We will also examine the role of medical
mistrust in shaping women’s use of healthcare services as well as experiences of stigma and
discrimination in healthcare settings, particularly among Black participants. In Baltimore, this mistrust is
particularly pronounced, with Johns Hopkins Hospital having a long history of mistrust in the Black
community owing to experimentation and deception of research engagement. The study will be guided by
a community advisory board (CAB) who will inform its design and implementation as well as engage in
disseminating the results at community meetings to inform COVID-testing scale up.

## Key facts

- **NIH application ID:** 10259440
- **Project number:** 3R01DA041243-05S2
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Susan G. Sherman
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $654,592
- **Award type:** 3
- **Project period:** 2020-12-01 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10259440

## Citation

> US National Institutes of Health, RePORTER application 10259440, Exploring barriers and facilitators to women who use drugs (WWUD) awareness, acceptance and uptake of COVID-19 testing, the CARE study. (3R01DA041243-05S2). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10259440. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*