Research Projects

Current Research Projects

Past Research Projects

Differences in HIV Outcomes and Quality of Life Between Older and Younger Black Women With HIV in the United States, 2021–2023.

Authors: LaShonda Y Spencer MD, Yvette P.Cuca PhD, MPH, Katy Davis PhD, LCSW, Vanessa Ayafor MD, MPH, Shakeila Lewis-Chery MPH, Clara A Chen MHS, Howard J. Cabral PhD, MPH, Lindey Furton MPH, Rahab Goodwin MPH, Natalie Solomon-Brimage MPH, and Serena Rajabiun PhD, MA, MPH

Abstract
Objectives
To characterize differences in outcomes of 733 Black women aged 50 years and older compared with younger women with HIV engaged in bundled interventions across 12 US sites from 2021 to 2023.

Methods
We examined age differences in physical component score (PCS) and mental component score (MCS) for health-related quality of life, stigma, and viral suppression over 12 months. We examined outcome effects by age and intervention. We collected comorbidities and preventive health screenings.

Results
Lower PCS was associated with each year with HIV for older women (b = −0.13; 95% confidence interval [CI] = −0.25, −0.02) and for younger women in the stigma reduction intervention (b = −3.36; 95% CI = −5.88, −0.84). Younger women in the intimate partner violence intervention demonstrated a decrease in MCS quality of life (b = −3.07; 95% CI = −5.16, −0.98). Stigma scores were increased for younger women in the Red Carpet Experience (b = 2.70; 95% CI = 0.07, 5.33) but lower for older women in the self-efficacy intervention (b = −1.41; 95% CI = −2.24, −0.57). Viral load suppression was associated with peer−patient navigation for older women (adjusted odds ratio [AOR] = 4.73; 95% CI = 1.51, 14.81) and the intimate partner violence intervention for younger women (AOR = 3.83; 95% CI = 2.15, 6.82). Health screenings were low.

Conclusions
Interventions that center Black women beyond traditional HIV treatment are needed with a focus on health screenings to improve the quality of life of older women.

(Am J Public Health. 2025;115(S1):S57 S67. https://doi.org/10.2105/AJPH.2025.308021)

Beyond Survival: Harnessing Sustainability Frameworks to Assess and Support Programs Implementing Bundled Interventions for Black Women With HIV

Authors: Angela Wanagari Walter PhD, MPH, MSW, Melanie Rocco MSW, MPH, Judith Scott PhD, LISCW, Ashley Carhee, Vanessa Ayafor MD, MPH, Rahab Goodwin, MPH, Shakeila A. Lewis-Chery MPH, Alicia Downes LMSW, LaShonda Y Spencer MD, AAHIVS, and Linda Sprague Martinez PhD

Abstract
Objectives
To evaluate the sustainability of bundled interventions aimed at expanding the delivery and utilization of HIV care and treatment services, tackling socio cultural health determinants, and improving health outcomes for Black women with HIV.

Methods
We used quantitative data from the Program Sustainability Assessment Tool (PSAT) to examine sustainability capacity across sites in the United States. Qualitative data from monthly call forms completed by site staff (n = 199), annual site visit reports (n = 24), and one-on-one key informant interviews (n = 76) informed organizational and contextual factors influencing sustainability capacity.

Results
A total of 59 stakeholders completed the PSAT. The initiative’s overall sustainability score was high (mean = 5.1; range = 3.8–6.6), with sites reporting favorably on program adaptation (mean = 5.8; range = 4.4–6.8), program evaluation (mean = 5.6; range = 3.9–7.0), and organizational capacity (mean = 5.6; range = 3.8–7.0) domains. Adaptability and responsiveness to client needs and sociopolitical contexts were determined valuable; establishing an evaluation infrastructure, capacity to integrate Black Women First (BWF) initiative activities within organizational operations, and environmental support facilitated sustainability.

Conclusions
Interventions for Black women with HIV can be sustained and should be pursued and embedded consistently in community and health service organizations.

(Am J Public Health. 2025;115(S1):S28–S37. https://doi.org/10.2105/AJPH.2024.307790)

Black Authoritative Knowledge and Health Care Among Black Women With HIV

Authors: Corliss D. Heath PhD, MPH, MDiv, Cynthia Tucker DrPH, and Mo Goodwin MPH

Abstract
Black women have higher rates of HIV than do White and Latina women. Additionally, numerous Black women face intersecting issues, such as intimate partner violence, trauma, homelessness, and mental health disorders. Gaps still exist in implementing culturally relevant or tailored interventions for Black women with HIV.

Culturally relevant bundled intervention approaches are needed that address social determinants of health, link Black women with HIV to care, engage and retain them in care, and improve outcomes and quality of life. Central to this is building community partnerships, meaningfully involving Black women with lived experiences in decision-making regarding their care and treatment, and implementing intervention strategies.

We show how Black authoritative knowledge centers Black women’s experiences and needs and promotes confidence to advocate for, empower, and inform others about their lives and health and how it becomes the basis of decision-making. We describe the use of authoritative knowledge in adapting and implementing strategies to uptake bundled evidence-informed interventions funded by the Minority HIV/AIDS Fund and the Health Resources and Services Administration’s HIV/AIDS Bureau Ryan White HIV/AIDS Program Special Projects of National Significance to help promote, shift, reimagine, and transform equitable HIV care for Black women.

(Am J Public Health. 2025;115(S1):S38–S45. https://doi.org/10.2105/AJPH.2024.307930)

Cancer Screening Rates, Disparities by Immigration Status and Predictors of Cancer Screening among Black Women with HIV

Authors: Ayafor, Vanessa MD, MPH; Downes, Alicia LMSW; Lewis-Chery, Shakeila MPH; Cabral, Howard J. PhD, MPH; Zhang, Xiyuan MPH; Goodwin, Rahab MPH; Spencer, LaShonda Y. MD; Rajabiun, Serena PhD, MA, MPH

Abstract
Introduction
People with HIV have a higher incidence and mortality from screenable cancers than the general population. Among women, the four most common cancers are breast, colorectal, lung, and cervical cancers. This study examined breast, colorectal, lung, and cervical cancer screening rates among Black women with HIV and disparities that exist by Immigration status.

Methods
With a sample of 604 women, we examined cancer screening rates for breast, colorectal, lung, and cervical cancers and examined the rates by country of origin. Generalized linear mixed models were used to examine potential factors affecting these rates and the odds of screening by country of origin: US-born women (USBW) and non-US-born women (NUSBW).

Results
Cancer screening rates were low for all cancer categories for both groups. A screening rate of 48.7% was estimated for breast cancer (NUSBW-35.9% versus USBW-50.4%), 6.3% for lung cancer, 25.5% for colorectal cancer, and 72.8% for cervical cancer. NUSBW had lower screening rates for all 4 cancers compared to USBW. Possible predictors for cancer screenings were years of living with HIV (OR 1.11; 95% CI 1.07-1.14) and no viral suppression (OR 0.34; 95% CI 0.15-0.76).

Conclusion
Black women with HIV and much more immigrant subgroups may face additional barriers to accessing required cancer screening services in addition to being disproportionately affected by HIV. This emphasizes the urgent need for tailored, culturally relevant outreach and education to enhance cancer screening.

Strategies to enhance linkages between care for HIV/AIDS in jail and community settings
Authors: Jeffery Draine, Divya Ahujaa, Frederick L. Altice, Kimberly Kacob Arriola, Ann K. Avery, Curt G. Beckwith, Cristina A. Booker, Ann Ferguson, Hayley Figueroa, Thomas Lincoln, Lawrence J. Ouellet, Jeffrey Porterfield, Anne C. Spaulding & Melinda J. Tinsley

Abstract
The policies of mass incarceration and the expansion of the criminal justice system in the USA over the last 40 years have weighed heavily on individuals and communities impacted by drug use and HIV disease. Though less than ideal, jails provide a unique opportunity to diagnose, treat and implement effective interventions. The role of jails in HIV detection, treatment, and continuity of care, however, has yet to be systematically examined. This paper reviews the service strategies and contexts for 10 demonstration sites funded to develop innovative methods for providing care and treatment to HIV-infected individuals in jail settings who are returning to their communities. The sites have implemented varied intervention strategies; each set in unique policy and service system contexts. Collaboration among agencies and between systems to implement these interventions is viewed as particularly challenging undertakings. We anticipate the sites will collectively serve 700–1000 individuals across the duration of the initiative. In this paper, we review the service contexts and strategies developed by the 10 sites. The individual and multi-site evaluations aim to provide new data on testing, treatment, and community linkages from jails that will further develop our knowledge base on effective intervention strategies in these settings.

The Role of Jails in Engaging PLWHA in Care: From Jail to Community

Authors: Richard C. Rapp, Rachel Ciomcia, Nick Zaller, Jeff Draine, Ann Ferguson & Robin Cagey

Abstract
HIV testing in jails has provided public health officials with the opportunity to not only identify new cases of HIV but to also reestablish contact with previously diagnosed individuals, many of whom never entered care following diagnosis or entered care but then dropped out. The presence of inmates throughout the HIV/AIDS continuum of care suggests that jails can play a strategic role in engaging persons living with HIV and AIDS in care. In order to be successful in structuring HIV/AIDS programs in jails, health care and correctional officials will be well-served to: (1) understand the HIV/AIDS continuum of care from the standpoint of engagement interventions that promote participation; (2) be aware of jail, community, and prison interventions that promote engagement in care; (3) anticipate and plan for the unique barriers jails provide in implementing engagement interventions; and, (4) be creative in designing engagement interventions suitable for both newly and previously diagnosed individuals.

Outcomes from the Adaptation of an Evidence-Based Peer Linkage & Re-Engagement Intervention for Women of Color with HIV in Three Urban Clinics

Authors: Serena Rajabiun, Janet Myers, Janet Goldberg, Karen Fortu, Marena Sullivan, Vladimir Berthaud, Rahab Wahome, Alicia Downes & Howard J. Cabral

Abstract
Peer interventions have demonstrated efficacy with improving HIV health outcomes. Yet, little is known about factors associated with their uptake into the clinic setting. Three urban sites in the US were funded to adapt, implement and evaluate a peer intervention to improve HIV health outcomes for 173 out of care and newly diagnosed women of color. Peers worked with cis and transgender women of color for four months to achieve the goals of linkage and retention in HIV case management and medical care. Results were 96% of women were linked to medical care, 73% were retained in care and 81% were virally suppressed post 12 months. The average duration of the peer intervention was seven months. Women who received four peer encounters had a 10% increase in retention in care and viral suppression. The findings highlight key elements such as dose and duration of client interaction for peer staff as part of the health care team.

Unmet Needs Among Out of Care and Recently Diagnosed Women of Color With HIV: Opportunities for Focused Interventions

Authors: Rajabiun, Serena PhD; Childs, Ellen PhD; Fortu, Karen MPH; Spencer, LaShonda Y. MD; Niles-Carnes, Larisa V. MPH; Wahome, Rahab MPH; Downes, Alicia LMSW; Heath, Corliss D. PhD, MPH, MDiv

Abstract
Objective
Women of color (WoC) have lower retention in care and higher HIV/AIDS-related morbidity, compared with other populations. Barriers to care include lack of family support, inadequate HIV/AIDS services, and stigma, and women may face greater unmet needs for services including housing and employment. This descriptive study explores the unmet needs of WoC participating in the Health Resources and Services Administration’s Special Projects of National Significance (SPNS) Program, Dissemination of Evidence Informed Interventions (HRSA/SPNS DEII) Initiative.

Setting
Six urban health clinics across the United States.

Participants
Eligible participants were cis- or transgender women who were newly diagnosed with HIV/AIDS in the past 12 months, out of care for at least 6 months, or not virally suppressed. Participants enrolled from November 2016 to November 2018.

Main Outcomes
Our primary outcome of interest was unmet needs at enrollment for 6 core services: housing, transportation, benefits, mental health or substance use treatment, medication assistance, and medical care. We examined differences in unmet needs stratified by participant characteristics and used multivariate regression to identify the social and health risk factors associated with higher unmet needs.

Results
Among the 529 WoC, the most frequently reported expressed needs were transportation (50.1%), housing (41.2%), benefits (28.2%), medication assistance (24.5%), and substance use or mental health treatment (24.3%). Participants with a significantly higher number of overall unmet needs included those who were older (40 years or older), were unstably housed, had a history of incarceration, identified as a transgender woman, were US born, had no caregiver responsibilities, and did not have a case manager at enrollment.

Conclusions
Our findings indicate the importance of screening for and developing focused strategies to address the unmet needs for WoC if viral suppression is to be achieved.