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

摘要 冠状病毒病2019年(新冠肺炎)大流行对人们的生活产生了前所未有的影响 全世界。然而，对艾滋病毒携带者(PLWH)的影响尚不清楚。新出现的证据表明 普华永道有类似或略高的新冠肺炎收购风险，新冠肺炎恶化的风险更高 结果，包括住院和死亡。然而，就像几项研究一样，数据一直是喜忧参半的 表明在临床结果上没有差别。几项研究还发现，结果更差的是 那些没有病毒抑制的人和那些CD4计数较低的人，突出了继续感染艾滋病毒的重要性 关心。然而，早期报告表明，新冠肺炎已经扰乱了整个艾滋病毒护理连续体系的服务。作为 大流行仍在继续，更好地描述COVID与结果之间的关系至关重要 在PLWH中。此外，我们需要确定大流行和公共卫生战略如何抗击 这场大流行影响了对长春市妇幼保健院的护理，以及是否会产生任何持久的不利影响。 大约40%的PLWH参加了医疗补助。拟议的项目将包括医疗补助受益人 来自27个州和华盛顿特区，2018年至2024年，保守估计为2500万 受益者和每年登记的275,000名妇女之家。医疗补助是对艾滋病毒队列的重要补充 研究是因为它为我们提供了广泛的数据，以评估地理位置、社会决定因素的差异 在社区一级以及在重要的亚人群中，提高卫生保健水平。我们将评估两国关系 艾滋病毒与新冠肺炎病之间的关系，包括因新冠肺炎和不良条件而住院 由于新冠肺炎(PASC)的类似冠状病毒的急性后遗症。我们还将评估COVID19的影响 关于提供预防艾滋病毒的护理和艾滋病毒护理的大流行。我们将评估整个HIV护理的护理 包括PrEP处方、HIV检测和每年的HIV护理访问、病毒负载测试和ARV 药物持有率。我们还将评估对提供非艾滋病毒疾病护理的影响， 包括年度健康检查、预防性筛查和健康状况管理。我们会比较一下 COVID前时期(2001-2019年)、急性COVID期(2020-2021年)和急性COVID后时期的护理率 期间(2022-2024)总体和按地理位置(州、城市/农村、地方政府地区[LGA]、 最小的政府区域，例如县、市、镇等)以及新冠肺炎病例和冠状病毒感染的地区严重性- 19条政策。这项拟议研究的结果将有助于提供信息并有针对性地进行干预，以改善对 未来的PLWH。

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.