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

项目摘要/摘要 持续的艾滋病毒流行和新冠肺炎大流行对种族和民族造成了不成比例的影响 少数群体。少数民族人群中艾滋病毒和新冠肺炎的诊断率、住院率和死亡率都较高 费率。健康的社会决定因素(SDoH)很可能是这些种族主义不平等的主要原因。至 在个人、结构和社区各级制定更有效的艾滋病毒干预措施，特别是在 在新冠肺炎的背景下，更好地了解加剧这些差异的SDoH决定因素是 急切需要。此外，艾滋病毒携带者严重感染新冠肺炎的风险增加。 慢性阻塞性肺疾病新冠肺炎诊断率和死亡率的增加可能与个体和 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，有效的新冠肺炎预防战略，如口罩强制要求，社会 疏远命令和疫苗可用来保护脆弱人口。使用链接的佛罗里达增强版 2020-2021年艾滋病毒/艾滋病报告系统数据和梅林新冠肺炎监测数据，本研究的主要 目标是(1)评估新冠肺炎社区预防战略的效果和影响 新冠肺炎疫苗的可获得性在降低威斯康星患者患新冠肺炎的风险及相关差异方面的作用；以及(2) 确定与社区中新冠肺炎和艾滋病毒高共存率相关的因素。我们的特定 目标是(1)确定与新冠肺炎差距相关的个人和社区层面的因素 用多水平模型研究疫苗接种前后重症肝炎的发病率和死亡率； 新冠肺炎和艾滋病高发区及相关社区因素的空间分析 统计和多水平模型；以及(3)识别新冠肺炎预防策略的不同效果(例如， 口罩强制、居家和社交疏远令)对威斯康星医院新冠肺炎发病率的比较 对未感染HIV的人群进行纵向趋势分析。这项研究为结束艾滋病毒流行做出了贡献 通过确定可修改的社区级因素来实现主动，这些因素与 一种可能对艾滋病毒流行产生负面影响的流行病。这些发现将有益于确定和 制定量身定做的预防战略，并在整个佛罗里达州进行资源分配。拟议的研究将 为Tendai Gwanzura提供实践培训，并在 针对艾滋病毒和新冠肺炎的高级社会差异流行病学方法；高级统计学 多水平建模和纵向趋势分析的方法；关于以下方面的卫生政策评估 新冠肺炎政策及其对威尔斯亲王的影响；以及地理空间统计，以确定最大 疾病的负担。这些培训将有助于使天台成为一个有成就的少数民族 博士前学生，以及独立的健康差距研究人员。

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.