At the Intersection of HIV and COVID-19: Medicaid Data as a Complement to Cohort Studies

HIV 和 COVID-19 的交叉点：医疗补助数据作为队列研究的补充

• 批准号: 10548472
• 负责人: Corinne E. Joshu
• 金额: $ 81.87万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-10 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10548472
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Acute; Acute Disease; Adverse effects; Age; Alcohols; Anti-Retroviral Agents; Area; CD4 Lymphocyte Count; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; COVID-19 risk; COVID-19 screening; COVID-19 severity; Caring; Cessation of life; Cities; Clinical; Cohort Studies; Communities; Complement; Continuity of Patient Care; County; Data; Diabetes Mellitus; Diagnosis; Disease; Enrollment; Epidemic; Ethnic Origin; Future; Geographic Locations; Geography; Goals; Government; HIV; HIV diagnosis; Health; Health Services Accessibility; Healthcare; Hepatitis C Therapy; Hospitalization; Human immunodeficiency virus test; Hyperlipidemia; Hypertension; Incidence; Inflammatory; Infrastructure; Inpatients; Intervention; Local Government; Medicaid; Medical; Mental Health; Operative Surgical Procedures; Outcome; Overdose; Persons; Pharmaceutical Preparations; Pneumonia; Policies; Population; Prevention; Preventive care; Preventive screening; Probability; Public Health; Race; Reporting; Risk; Risk Factors; SARS-CoV-2 infection; Screening for cancer; Services; Symptoms; Syndrome; Telemedicine; Testing; Time; United States; Viral; Viral Load result; Visit; Washington; Work; acute care; adverse outcome; base; behavioral health; beneficiary; combat; comorbidity; comparison group; coronavirus disease; geographic difference; health care service utilization; high risk; improved; interest; pandemic disease; pre-exposure prophylaxis; regional difference; remote health care; rural setting; screening; severe COVID-19; sex; social health determinants; uptake

ABSTRACT The Coronavirus Disease 2019 (COVID-19) pandemic has had an unprecedented impact on the lives of people worldwide. Yet, the effect on persons living with HIV (PLWH) is not known. Emerging evidence suggests that PLWH have a similar or modestly higher risk of COVID-19 acquisition, and higher risk for worse COVID-19 outcomes, including hospitalization and death. However, the data has been mixed as several studies have suggested no difference in clinical outcomes. Several studies also found that outcomes are worse among those without viral suppression and those with lower CD4 counts, highlighting the importance of continued HIV care. Yet, early reports suggest that COVID-19 has disrupted services across the HIV care continuum. As the pandemic continues to unfold, it is critical to better characterize the relationship between COVID and outcomes among PLWH. In addition, we need to identify how the pandemic and the public health strategies to combat the pandemic impacted the provision of care for PLWH, as well as whether any adverse effects are lasting. Approximately 40% of PLWH are enrolled in Medicaid. The proposed project will include Medicaid beneficiaries from 27 states and Washington, DC between 2018 and 2024 with a conservative estimate of 25 million beneficiaries and 275,000 PLWH enrolled annually. Medicaid is an important complement to HIV cohort studies as it affords us the breadth of data to evaluate differences by geographic location, social determinants of health at the community level, as well as among important sub-populations. We will assess the relationship between HIV and COVID-19 disease, including on hospitalization due to COVID-19 and adverse conditions due to COVID like post-acute sequala of COVID-19 (PASC). We will also evaluate the impact of the COVID19 pandemic on the provision of care for prevention of HIV and HIV care. We will assess care across the HIV care continuum including PrEP prescription, HIV testing, and annual HIV care visits, viral load tests, and ARV medication possession ratio. We will also evaluate impacts on the provision of care for non-HIV conditions, including annual wellness visits, preventive screenings and health condition management. We will compare care rates during the pre-COVID period (2001-2019), acute COVID period (2020-2021), and post-acute COVID period (2022-2024) overall and by geographic location (state, urban/rural, local government area [LGA], smallest government region e.g. county, city, town, etc.) and regional severity of COVID-19 cases and COVID- 19 policies. Findings from the proposed study will help inform and target interventions to improve care for PLWH in the future.

抽象的 2019 年冠状病毒病（COVID-19）大流行对人们的生活产生了前所未有的影响 全世界。然而，对艾滋病毒感染者（PLWH）的影响尚不清楚。新出现的证据表明 PLWH 感染 COVID-19 的风险相似或稍高，并且感染 COVID-19 的风险更高 结果，包括住院和死亡。然而，数据好坏参半，因为多项研究表明 表明临床结果没有差异。几项研究还发现，结果更差 那些没有病毒抑制的人和那些 CD4 计数较低的人，强调了持续艾滋病毒的重要性 关心。然而，早期报告表明，COVID-19 已经扰乱了整个艾滋病毒护理连续体的服务。作为 大流行继续蔓延，更好地描述新冠病毒与结果之间的关系至关重要 感染者之中。此外，我们需要确定如何应对这一流行病和公共卫生战略 大流行影响了为感染者提供的护理，以及是否有任何不利影响是持久的。 大约 40% 的 PLWH 参加了医疗补助计划。拟议项目将包括医疗补助受益人 2018 年至 2024 年间，来自 27 个州和华盛顿特区，保守估计为 2500 万 每年有 275,000 名感染者和受益者参加。医疗补助是艾滋病毒队列的重要补充 研究，因为它为我们提供了广泛的数据来评估地理位置、社会决定因素的差异 社区一级以及重要亚人群的健康状况。我们将评估双方关系 HIV 和 COVID-19 疾病之间的关系，包括因 COVID-19 和不利条件而住院的情况 由于像 COVID-19 (PASC) 急性后遗症这样的新冠病毒。我们还将评估新冠肺炎疫情的影响 为预防艾滋病毒和艾滋病毒护理提供护理。我们将评估整个艾滋病毒护理的护理 连续体，包括 PrEP 处方、HIV 检测、年度 HIV 护理就诊、病毒载量检测和 ARV 药品拥有率。我们还将评估对非艾滋病毒状况护理的影响， 包括年度健康检查、预防性筛查和健康状况管理。我们会比较 新冠肺炎前期（2001-2019 年）、新冠急性期（2020-2021 年）和新冠急性期后的护理率 期间（2022-2024）总体和按地理位置（州、城市/农村、地方政府区域 [LGA]、 最小的政府区域，例如县、市、镇等）以及 COVID-19 病例和 COVID-19 病例的区域严重程度 19项政策。拟议研究的结果将有助于提供信息并确定干预措施的目标，以改善对患者的护理 未来的感染者。