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

项目概要/摘要 持续的艾滋病流行和COVID-19大流行对种族和族裔的影响不成比例 少数群体。少数民族人群的HIV和COVID-19诊断率、住院率和死亡率较高 rates.健康的社会决定因素（SDoH）最有可能是这些种族化的不平等的主要原因。到 * 在个人、结构和社区层面采取更有效的艾滋病毒干预措施，特别是 在COVID-19的背景下，更好地了解加剧这些差异的SDoH决定因素， 迫切需要。此外，艾滋病毒感染者（PWH）感染严重COVID-19的风险增加。 威尔斯亲王医院的COVID-19诊断率和死亡率增加可能与个人和 社会生态模型中提出的社区因素，如果确定，可以有针对性地创造更好的 干预策略。此外，有效的COVID-19预防策略，如口罩规定，社会 隔离令和疫苗可用于保护弱势群体。使用链接的佛罗里达增强 2020-2021年的艾滋病毒/艾滋病报告系统数据和Merlin COVID-19监测数据，本研究的主要 目标是（1）评估COVID-19社区预防策略的效果以及 2019冠状病毒病疫苗的可用性，以降低威尔斯亲王医院感染2019冠状病毒病的风险及相关差异;及（2） 确定与各社区COVID-19和艾滋病毒同时高发相关的因素。我们的具体 目标是（1）确定与COVID-19差异相关的个人和社区层面因素 使用多水平模型，在疫苗可用之前和之后，PWH的发病率和死亡率;（2）识别 COVID-19和HIV高发病率的双重热点，以及使用空间分析的相关社区因素 统计和多层次模型;以及（3）识别COVID-19预防策略的差异效应（例如， 戴口罩、留在家中及保持社交距离令）对威尔斯亲王医院2019冠状病毒病发病率的影响 没有感染艾滋病毒的人使用纵向趋势分析。这项研究有助于结束艾滋病毒的流行 通过确定社区一级可改变的因素， 一种可能对艾滋病流行产生负面影响的流行病。这些发现将有助于识别和 制定有针对性的预防战略，并在整个佛罗里达的资源分配。拟定的研究将 为Tendai Gwanzura提供实践培训，并在以下方面提供补充教学培训和指导 针对艾滋病毒和COVID-19的先进社会差距流行病学方法;先进的统计 多层次建模和纵向趋势分析方法; COVID-19政策及其对威尔斯亲王医院的影响;以及地理空间统计数据，以确定 疾病负担。这些培训将有助于使Tendai成为一个有成就的少数民族 博士前学生和独立的健康差异研究员。

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.