# Interrupting HIV and TB stigma in the household during TB contact investigation in Uganda

> **NIH NIH R21** · YALE UNIVERSITY · 2020 · $180,291

## Abstract

PROJECT SUMMARY/ABSTRACT
With widespread access to high-quality HIV treatment, awareness of HIV status remains among the most
important barriers to public health control of HIV in sub-Saharan Africa, especially among key populations
including adolescents, men, and close contacts of TB patients. Household testing by lay health workers offers a
proven approach for reaching such populations, but rates of test acceptance remain unacceptably low. Stigma
related to both HIV and TB contribute to low uptake, and may be reinforced by social interactions at the
household level. A century of behavioral science research on individual decision-making in group contexts
strongly suggests that optimizing the order of test invitations to establish testing as the normative choice, framing
testing as a prosocial behavior, and offering a less invasive test is likely to reduce stigma and improve uptake of
testing. Therefore, this application proposes a series of preliminary, prospective, mixed-methods studies with
household members of TB patients and lay health workers delivering routine household contact investigation for
TB and HIV in Kampala, Uganda. The overall objective of these studies will be to evaluate the feasibility,
acceptability, and preliminary effectiveness of a complex behavioral intervention to reduce stigma and promote
HIV testing uptake among household members of TB patients. The innovative testing strategy includes three
components, 1) acceptance-optimized sequencing of test invitations, 2) prosocial messaging, and 3) oral HIV
testing. In Aim 1, the novel test invitation strategy will be evaluated and iteratively refined based on serial
qualitative data collection with health workers and household contacts, as well as before-and-after surveys of
contacts using validated stigma scales selected for their utility for TB- and HIV-specific stigma at the household
level. In Aim 2, the strategy will be prospectively evaluated for its effects on stigma and test uptake in a pre-post
implementation design. A multi-disciplinary research team includes experts in case-finding for TB-HIV, social
sciences, and implementation research working in close partnership with public health officials; they also have
experience in building local research capacity in implementation science. The expected impact is to generate
preliminary data on a novel approach to offering home testing that reduces layered HIV-TB stigma in households,
and on its effects on testing and linkage to and retention in care, built on the strong scientific premise of
longstanding research on social decision-making. The project will also enhance local capacity by supporting a
local doctoral student on the project team and sponsoring annual scientific symposia on HIV-TB stigma at
Makerere University, with the goal of engaging a broad group of stakeholders to advance a local research agenda
in this area. These data will inform a future randomized study evaluating the clinical impact of these innovativ...

## Key facts

- **NIH application ID:** 9914145
- **Project number:** 5R21TW011270-02
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** John Lucian Davis
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $180,291
- **Award type:** 5
- **Project period:** 2019-04-15 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9914145

## Citation

> US National Institutes of Health, RePORTER application 9914145, Interrupting HIV and TB stigma in the household during TB contact investigation in Uganda (5R21TW011270-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/9914145. Licensed CC0.

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