Addressing community-level influences of HIV and COVID-19 disparities among people with HIV

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FIU-RCMI Research Project #3 Abstract The twin pandemics of human immunodeficiency virus (HIV) and COVID-19 share uncanny similarities with respect to racial/ethnic and socioeconomic disparities in both incidence and mortality. Structural strategies for HIV and COVID-19 outcomes could augment current agent-based (individual-level) interventions by addressing those factors that limit a person's ability to carry out risk reduction, as well as address transmission among people not easily reached by agent-based interventions. The primary objectives of this study are: (a) to identify modifiable community-level influences on gender, racial/ethnic, and rural/urban disparities in HIV and COVID-19 outcomes among people with HIV; and (b) to develop policy and programmatic recommendations to address these community-level influences. The proposed study will use individual-level 2017-2023 Florida HIV/AIDS surveillance data linked to individual-level 2020-2023 Florida COVID-19 surveillance data. Linked HIV and COVID-19 data will be merged with 10 additional census tract- and county- level community data for Florida. Using a mix of complex analytical approaches and guided by ecosocial theory and the National Institute on Minority Health and Health Disparities research framework, we propose to examine community factors that impact health disparities across 5 domains of influence: (1) biological, (2) behavioral, (3) physical/built environment, (4) sociocultural environment, and (5) health care system. Additionally, the proposed study will convene a strategic planning workgroup of HIV leaders across Florida to develop recommendations to address community influences of HIV and COVID-19 disparities among people with HIV. We propose three specific aims: Aim 1. Estimate the moderating effect of community factors on the association between gender, race/ethnicity, and rural/urban residence and both differences (from pre-COVID- 19 [2017-2019] to the acute period of the COVID-19 Pandemic [2020]) and trajectories (from pre-COVID-19 [2017-2019] through the evolving periods of the COVID-19 Pandemic [2020-2023]) in HIV outcomes among people with HIV. Aim 2. Estimate the moderating effect of community factors on the association between gender, race/ethnicity, and rural/urban residence and COVID-19 outcomes during the acute (2020) and evolving (2020-2023) periods of the COVID-19 Pandemic among people with HIV. Aim 3. Develop policy and programmatic recommendations to address community influences of gender, racial/ethnic, and rural/urban disparities in HIV and COVID-19 outcomes among people with HIV. Findings from this study will provide a novel understanding of the impact of community context on COVID-19 and HIV disparities among people with HIV, as well as develop an actionable plan to protect vulnerable populations of people with HIV and support the goals of Ending the HIV Epidemic in the COVID-19 era. This study further supports NIH's 2021-2025 research priority areas of studying HIV comorbidities and syndemics, and of focusing on community and social- structural factors influencing inequities in HIV outcomes.