Across the Duke University School of Nursing, faculty are designing nurse-led health care interventions and solutions that reduce health inequity among people living with HIV.

Faculty conducting vital research related to HIV/AIDS include:

Brandon Knettel, PhD
Assistant Professor
Research focus: Improving mental health and reducing stigma among people living with HIV in diverse settings, both in the U.S. and in Tanzania.

“Suicide is a leading cause of death among people living with HIV worldwide, but few interventions exist,” said Knettel.

In Tanzania, Knettel and his team are implementing nurse-led screening for suicidal thinking among people living with HIV and connecting patients to nurse-delivered telehealth counseling. In North Carolina, the team is looking at the overlapping syndemics of HIV and opioid use to try to improve health outcomes. Both mental health and opioid use disproportionately affect underserved communities.

“I am dedicated to this work because I envision a world where all people living with HIV can lead a healthy life, free of stigma,” said Knettel. “Suicidal thinking and opioid use are deadly problems, and we want to be sure that people living with HIV have access to life-saving treatments for these challenges. By improving treatment access and addressing social determinants of health among people living with HIV, we can improve the health of these individuals and save lives.”

Schenita D. Randolph, PhD, MPH, RN, CNE
Ragan Johnson, DNP, MS, APRN-BC
Associate Professors
Research focus: Shifting the approach to sexual health among Black AYA with the first nurse-led, parent-adolescent intervention providing tools for parents to address HIV risk transmission and racial discrimination as interrelated public health issues. Additionally, addressing sexual health inequities among Black women by addressing barriers to HIV pre-exposure prophylaxis (PrEP), a medication if taken consistently decreases HIV risk, such as PrEP stigma and distrust.

“We, in the HEEAT Lab, want our interventions to be practical, impactful and meaningful to the community in reaching health outcomes,” said Randolph. “If the research does not translate into clinical or community practice, we believe it lessens our impact and purpose. We also acknowledge the time, resources, and financial commitments that are made throughout the research process and wish for our work to be useful beyond grant funding for the communities that are most affected.”

Although there has been immense progress in curbing the HIV/AIDS epidemic, there remains work to do.

“Amazing work has been done in HIV prevention and care,” Randolph said. “For example, PrEP has been found to be 99 percent effective in preventing HIV in those who take it consistently however, only 1 to 2 percent of Black cisgender women who could benefit from it actually use it.”

The Centers for Disease Control and Prevention has evidence-based interventions that focus on improving PrEP uptake, yet these interventions focus on men having sex with men (MSM), there are none to date for women, and none for women of color.

“This should alarm us given that cisgender women account for 19 percent of all new HIV infections primarily due to heterosexual transmission, among which 57 percent are Black cisgender women,” said Randolph. “HIV can affect all populations, across age, socioeconomic status, and gender and we must shift the way we communicate our messaging around HIV prevention to be inclusive. If populations are not seeing themselves in the messaging, then our strategies around inclusivity need to be re-evaluated.”

Marta Mulawa, PhD, MHS
Assistant Professor
Research focus: Developing and testing a smartphone app-delivered intervention to support adolescents and young adults with HIV in Cape Town, South Africa.

“The young people we work with are excited by the potential of these types of interventions to reach young people struggling with HIV care engagement and to provide supportive online communities that can reduce the social isolation many young people with HIV experience regularly,” said Mulawa.

Mulawa’s research team includes young people with HIV who have a track record of good treatment adherence who serve as peer mentors and support other adolescents and young adults through the digital platform.

“Young people experience significant disparities in HIV-related morbidity and mortality compared to other age groups,” Mulawa said. “We need interventions designed by young people, for young people, to address the unique challenges they face. To end the epidemic, I believe we need approaches that center young people with HIV to identify solutions based on their unique circumstances.”

Michael V. Relf, PhD, RN, ACNS-BC, AACRN, ANEF, CNE, FAAN
Associate Dean for Global and Community Health Affairs
Associate Professor
Research focus: Expanding nursing science’s role throughout the epidemic and lookings at the psychosocial aspects of HIV using mixed-methods particularly focusing on intimate partner violence, HIV-related stigma, intersectional stigma, and experiences with everyday discrimination among persons living with HIV.

Vincent Guilamo-Ramos, PhD, MPH, LCSW, RN, ANP-BC, PMHNP-BC, FAAN
Dean and Vice Chancellor for Nursing Affairs, Duke University
Professor
Research focus: Latino adolescent sexual reproductive health policy, practice, and science; reduction of stigma of youth  and young people living with HIV/AIDS; and the role of nurses in ending the HIV epidemic.