# 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

> **NIH NIH F31** · JOHNS HOPKINS UNIVERSITY · 2022 · $46,753

## Abstract

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.

## Key facts

- **NIH application ID:** 10480527
- **Project number:** 1F31MH128079-01A1
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Carrie Elizabeth Lyons
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $46,753
- **Award type:** 1
- **Project period:** 2022-04-01 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10480527

## Citation

> US National Institutes of Health, RePORTER application 10480527, 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 (1F31MH128079-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10480527. Licensed CC0.

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