Identifying individual and community factors associated with high COVID-19 incidence and mortality rates among people with HIV.

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Project Summary/Abstract The ongoing HIV endemic and the COVID-19 pandemic have disproportionately affected racial and ethnic minority groups. Minority populations have higher HIV and COVID-19 diagnosis, hospitalization, and mortality rates. Social determinants of health (SDoH) are most likely the main cause of these racialized inequities. To create more efficient HIV interventions acting at the individual, structural, and community levels, particularly in the context of COVID-19, a better knowledge of the SDoH determinants that exacerbate these discrepancies is urgently required. Further, people with HIV (PWH) are at increased risk of severe COVID-19 infections. Increased rates of COVID-19 diagnosis and mortality among PWH are likely associated with individual and community factors as proposed in the socio-ecological model, that if identified, can be targeted to create better intervention strategies. Further, effective COVID-19 prevention strategies such as mask mandates, social distancing orders, and vaccines are available to protect vulnerable populations. Using linked Florida Enhanced HIV/AIDS Reporting System data and Merlin COVID-19 surveillance data for 2020-2021, this study’s primary objectives are to (1) assess the effect of COVID-19 community-level prevention strategies and the impact of COVID-19 vaccine availability in reducing the risk of COVID-19 in PWH and related disparities; and (2) to identify factors associated with co-occurring high rates of COVID-19 and HIV across communities. Our specific aims are to (1) identify individual- and community-level factors associated with disparities in COVID-19 incidence and mortality among PWH before and after vaccine availability using multi-level models; (2) identify dual hotspots of high COVID-19 and HIV incidence rates, and associated community factors using spatial statistics and multilevel models; and (3) identify the differential effect of COVID-19 prevention strategies (e.g., mask mandates, stay at home and social distancing orders) on COVID-19 incidence rates in PWH compared to people without HIV using longitudinal trend analysis. This study contributes to the Ending the HIV Epidemic Initiative by identifying modifiable community-level factors associated with the synergistic effects of more than one epidemic that may negatively impact the HIV endemic. The findings will be beneficial in identifying and developing tailored prevention strategies and in resource allocation across Florida. The proposed study will provide hands-on training for Tendai Gwanzura’s and complementary didactic training and mentorship in advanced social disparities epidemiology methods specific to HIV and COVID-19; advanced statistical methods in multilevel modelling and longitudinal trend analysis; health policy assessment with regards to COVID-19 policies and how they affect PWH; and geo-spatial statistics to identify locations with the greatest burden of disease. These trainings will contribute towards making Tendai, an accomplished minority predoctoral student, and an independent health disparities researcher.