Multi-level stigma mitigation intervention for women living with HIV in blantyre, malawi

The Department of Health and Human Services National Institutes of Health Fogarty International Center awarded The Johns Hopkins University $1,024,773 on September 15, 2025, under the International Research and Research Training program (CFDA 93.989) to adapt and assess a multi-level intervention package targeting stigma-driven barriers to antiretroviral therapy adherence and viral suppression among women living with HIV in Blantyre, Malawi.

The intervention addresses stigma at interpersonal, community, organizational, and structural levels to improve ART adherence, reduce enacted stigma in healthcare and community settings, and strengthen economic stability, social support, and mental health outcomes. The research builds on a 30-year collaboration among Johns Hopkins University, the Malawi Ministry of Health, and Kamuzu University of Health Sciences. Work is performed in Baltimore, Maryland, with a period of performance through June 30, 2028.

Kamuzu University of Health Sciences is the sub-grantee, responsible for obtaining IRB approvals, conducting staff training and community sensitization, recruiting and enrolling approximately 100 women living with HIV and approximately 40 health care workers, administering study visits and questionnaires, conducting clinical investigations and laboratory evaluations, minimizing protocol deviations, managing ongoing regulatory submissions, and contributing to manuscript writing, results interpretation, and dissemination. The sub-award was obligated on September 4, 2026.

Abstract

The proposed research aims to adapt and assess a multi-level intervention package to improve antiretroviral 3 therapy (art) adherence and viral suppression among women living with HIV (wlhiv) across the lifespan in 4 blantyre, malawi. This proposed intervention aims to achieve and maintain viral suppression through improved 5 art by addressing challenges related to experiences across interpersonal, community, organizational, and 6 structural levels. Wlhiv in malawi experience challenges including violence, social isolation, limited access to 7 quality healthcare, and economic instability. These experiences are often driven by stigma related to HIV and 8 perceived risk behaviors that create obstacles for women and ultimately, epidemic control for HIV. In response, 9 interventions that can reduce both the occurrence and impact of stigma are needed to effectively improve 10 access to quality care, its uptake, and HIV outcomes among women. In response, we have developed a 11 practical, multi-level intervention package that targets facilitators and drivers of stigma at the organizational, 12 community, and interpersonal levels to achieve optimal HIV outcomes. The package aims to innovatively 13 combine evidence-based program components to reduce 1) the occurrence of enacted stigma in interpersonal, 14 community, and healthcare settings, and 2) interrupt key mechanisms through which stigma affects health by 15 improving economic stability, social support, and mental health. This study builds on a strong collaboration of 16 more than 30 years between the johns hopkins university, the malawi ministry of health and the kamuzu 17 university of health sciences in blantyre, malawi. To accomplish this goal, our specific aims are: 1: adapt a 18 multilevel intervention package for wlhiv in blantyre, malawi using the adapt-ITT model; 2: implement a 19 pilot trial of the adapted multi-level intervention package among wlhiv in blantyre, malawi; and 3: evaluate 20 the implementation process of the adapted multi-level intervention using the consolidated framework for 21 implementation research (cfir). Reducing the occurrence and impact of stigma has the potential to support 22 long-term viral suppression, improved health outcomes, and higher quality of life among wlhiv across the 23 lifespan in malawi. This experienced, multi-disciplinary investigative team brings together clinical, 24 epidemiological, and research expertise across HIV, mental health, stigma measurement and intervention 25 development, as well as decades of experience in clinical trials, research-practice partnerships, and 26 community engagement in malawi. Our study design elements reflect these rich experiences and leverage 27 both implementation science and conventional observational/interventional approaches.