Wednesday, January 7, 2026 1/7/2026

Multi-level and Intersectional Stigma and other Social Determinant Effects on TB Case Detection, Care, and Treatment Outcomes: The MISSED TB Outcomes Study

Award Number: R01AI150485
ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 12/01/2020
PERIOD OF PERFORMANCE END DATE: 11/30/2026

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Multi-level and Intersectional Stigma and other Social Determinant Effects on TB Case Detection, Care, and Treatment Outcomes: The MISSED TB Outcomes Study - In 2018, ~10 million individuals developed TB disease globally, of which ~1.5 million died; HIV was the leading cause of death. Ongoing transmission results from an estimated 4.3 million “missing” TB cases along with active TB cases not retained in care. We will conduct our study in South Africa (TB prevalence=852/100,000 population; HIV co-infection=>50%), where a recent TB cascade analysis and national TB program indicators report significant gaps along the entire TB care cascade. Qualitative studies suggest community attitudes towards TB, along with other community- and individual-level factors impact TB stigma as a barrier to case finding, treatment, and adherence. Few studies have quantified the impact of stigma these factors on the TB care cascade, fewer have used validated stigma measures, and none utilized prospective, full care cascade designs. We propose a 4-aim, rigorous, multilevel, mixed-methods study. We will perform household surveys to aggregate into community-level data and incorporate into the analysis of all aims. Aim 1: Utilize mixed-methods to identify and measure individual- and community-level attitudes and related factors stigma and social determinants associated with presentation for TB testing among actively referred contacts. We will conduct a prospective study amongst symptomatic HHCs actively referred for testing (n= 750) to investigate the relationships within and between these individual- and community-level factors multiple levels of TB and HIV stigma and other social determinants and uptake of TB testing. Aim 2: Utilize mixed-methods to identify and measure individual- and community-level attitudes and related factors stigma and social determinants associated with returning for test results among individuals tested for TB. We will conduct a prospective study of individuals with TB symptoms who passively present to a study clinic and are tested for TB (n= 1000) to investigate the relationships between these individual- and community-level factors the multiple levels of TB and HIV stigma and other social determinants and returning for or obtaining test results. Aim 3: Utilize mixed-methods to identify and measure individual- and community-level attitudes and related factors stigma and social determinants associated with LTFU and treatment outcomes among individuals initiated on TB treatment. We will conduct a prospective study among TB patients initiating treatment (n= 1250) to investigate the association of fear, isolation, and shame related to TB anticipated, enacted and internalized TB and HIV stigma on LTFU and poor TB treatment outcomes. Qualitative methods will explore the trajectory, persistence, and impact of perceived and experienced TB stigmathese experiences during and after treatment. Aim 4: Utilize mixed-methods to identify and measure individual- and community-level attitudes and related factorsstigma and social determinants associated with LTFU from HIV care following TB treatment among co-infected individuals. Relevant data for TB/HIV co-infected participant previously collected as part of Aim 3 (n= ~600), and additional HIV outcome data will be used. Through this, we will investigate the presence and potential impact of intersecting stigmasattitudes and experiences related to TB and HIV on retention in HIV care following completion of TB treatment. This study will ultimately inform targeted, multi-level interventions, rooted in the needs and challenges of communities, theoretically informed, and fully contextualized, to address the TB crisis in South Africa, and inform similar interventions globally.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $0 )
2026	2025	DESMOND TUTU HEALTH FOUNDATION	3 WOODLANDS ROAD	CAPE TOWN	WESTERN CAPE			ZAF	Allergy and Infectious Diseases Research	000	5	10/7/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2025 ( Subtotal = $584,233 )
2025	2025	DESMOND TUTU HEALTH FOUNDATION	3 WOODLANDS ROAD	CAPE TOWN	WESTERN CAPE			ZAF	Allergy and Infectious Diseases Research	000	5	9/26/2025	NON-COMPETING CONTINUATION	$584,233
														Subtotal = $584,233

Issue Date FY: 2024 ( Subtotal = $539,769 )
2024	2024	DESMOND TUTU HEALTH FOUNDATION	3 WOODLANDS ROAD	CAPE TOWN	WESTERN CAPE			ZAF	Allergy and Infectious Diseases Research	001	4	4/24/2024	NON-COMPETING CONTINUATION	$57,135
2024	2024	DESMOND TUTU HEALTH FOUNDATION	3 WOODLANDS ROAD	CAPE TOWN	WESTERN CAPE			ZAF	Allergy and Infectious Diseases Research	000	4	2/8/2024	NON-COMPETING CONTINUATION	$482,634
														Subtotal = $539,769

Issue Date FY: 2023 ( Subtotal = $523,707 )
2023	2023	DESMOND TUTU HEALTH FOUNDATION	3 WOODLANDS ROAD	CAPE TOWN	WESTERN CAPE			ZAF	Allergy and Infectious Diseases Research	000	3	1/27/2023	NON-COMPETING CONTINUATION	$523,707
														Subtotal = $523,707

Issue Date FY: 2022 ( Subtotal = $538,149 )
2022	2022	DESMOND TUTU HIV FOUNDATION	FHS WERHNER BEIT NORTH ANZOI RD	CAPE TOWN				ZAF	Allergy and Infectious Diseases Research	000	2	12/1/2021	NON-COMPETING CONTINUATION	$538,149
														Subtotal = $538,149

Issue Date FY: 2021 ( Subtotal = $581,520 )
2021	2021	DESMOND TUTU HIV FOUNDATION	FHS WERHNER BEIT NORTH ANZOI RD	CAPE TOWN				ZAF	Allergy and Infectious Diseases Research	001	1	12/14/2020	NEW	$0
2021	2021	DESMOND TUTU HIV FOUNDATION	FHS WERHNER BEIT NORTH ANZOI RD	CAPE TOWN				ZAF	Allergy and Infectious Diseases Research	000	1	11/23/2020	NEW	$581,520
														Subtotal = $581,520

Grand Total All Awards = $2,767,378

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Multi-level and Intersectional Stigma and other Social Determinant Effects on TB Case Detection, Care, and Treatment Outcomes: The MISSED TB Outcomes Study

Award Number: R01AI150485

ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 12/01/2020

PERIOD OF PERFORMANCE END DATE: 11/30/2026

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