The impacts of HIV-related service interruptions during COVID-19 pandemic in South Carolina

摘要 全球新冠肺炎疫情给卫生系统带来了前所未有的压力，并中断了 针对包括艾滋病毒在内的其他主要健康状况的公共卫生努力。形式上的艾滋病毒服务中断 重新部署工作人员、重新分配资源、缺乏设备和药品(例如，艾滋病毒/性传播感染短缺 检测试剂盒、紧张的药品供应链)以及减少获得护理的机会(例如，旅行限制、封锁)可能 对艾滋病毒治疗的级联结果产生深远和长期的影响，特别是考虑到 大流行的性质。在处理艾滋病毒服务方面，现有文献中存在几个空白 中断及其后果。这些差距包括缺乏使用大规模的、真实的、多类型的 有理论指导的数据；对单一或有限的艾滋病毒治疗级联结果的关注；以及 努力确定可减轻此类干扰的负面影响的因素，以告知潜在的 州或地方一级的干预和能力建设。针对NOT-AI-21-057，我们建议 全面调查新冠肺炎大流行期间的艾滋病毒服务中断 社会生态学模型，评估它们对艾滋病毒预防和治疗级联的各种结果的影响， 并确定用于缓冲中断对艾滋病毒治疗级联结果的影响的复原力资源。 具体地说，我们将评估自2020年以来南卡罗来纳州(SC)的艾滋病毒服务中断情况 瑞安·怀特艾滋病毒诊所的报告数据，对诊所领导和提供者的深度访谈数据，以及艾滋病毒 基于电子健康记录(EHR)和基于公开手机的服务使用数据 艾滋病毒诊所的访问数据。我们将进一步探讨艾滋病毒服务中断如何影响艾滋病毒预防和 基于多种类型数据集的集成在适当的地理空间单元处的治疗级联结果 (例如，EHR、地理空间数据)。最后，我们将确定机构、社区和 结构性因素(例如，复原力资源)，可减轻艾滋病毒服务的不利影响 基于定量(EHR数据、在线调查数据)和定性(在--)的三角测量的中断 深度访谈、焦点小组讨论)有关卫生基础设施、社会资本和 组织准备。我们提出的研究可以更好地理解复杂的艾滋病毒 SC中的服务中断和可减轻此类中断对 各种艾滋病毒治疗的级联结果。通过数据识别的多层次弹性资源 三角测量将协助南加州卫生部门和社区制定战略计划，以应对 这一不断演变的流行病和未来的其他突发公共卫生事件(例如，猴痘、由 气候变化)。研究结果还可以为公共卫生政策的制定和其他国家的实践提供参考 有相似社会文化背景和艾滋病毒服务中断经历的南方腹地州 大流行。

Abstract The global COVID-19 pandemic has imposed unprecedented pressure on health systems and has interrupted public health efforts for other major health conditions, including HIV. HIV service interruptions in the forms of redeployment of staff, reallocation of resources, lack of equipment and medicine (e.g., shortages of HIV/STI testing kits, strained drug supply chain), and reduced access to care (e.g., travel restrictions, lock downs) may have a profound and long-term impact on HIV treatment cascade outcomes, especially given the evolving nature of the pandemic. There are several gaps in the existing literature in addressing HIV service interruptions and their consequences. These gaps include a lack of using large-scale, real-world, multi-type data with theoretical guidance; the focus on single or limited HIV treatment cascade outcomes; and limited efforts to identify factors that can mitigate the negative impacts of such interruptions to inform potential interventions and capacity building at state or local levels. In response to NOT-AI-21-057, we propose to comprehensively investigate HIV service interruptions during the COVID-19 pandemic following a socioecological model, assess their impacts on various outcomes of the HIV prevention and treatment cascade, and identify resilience resources for buffering impacts of interruptions on HIV treatment cascade outcomes. Specifically, we will assess HIV service interruptions in South Carolina (SC) since 2020 using operational report data of Ryan White HIV clinics, in-depth interview data with clinic leaders and providers, and HIV service utilization data based on both electronic health records (EHR) and publicly available cellphone-based HIV clinics visitation data. We will further explore how HIV service interruptions affects HIV prevention and treatment cascade outcomes at appropriate geospatial units based on the integration of multi-type datasets (e.g., EHR, geospatial data) from multiple sources. Finally, we will identify institutional-, community-, and structural-level factors (e.g., resilience resources) that may mitigate the adverse impacts of HIV service interruptions based on the triangulation of quantitative (EHR data, online survey data) and qualitative (in- depth interviews, focus group discussion) data regarding health infrastructure, social capital, and organizational preparedness. Our proposed research can lead to a better understanding of complicated HIV service interruptions in SC and resilience factors that can mitigate the negative effects of such interruptions on various HIV treatment cascade outcomes. The multi-level resilience resources identified through data triangulation will assist SC health departments and communities in developing strategic plans in response to this evolving pandemic and other future public health emergencies (e.g., monkeypox, disasters caused by climate change). The research findings can also inform public health policymaking and the practices of other Deep South states with similar sociocultural contexts and experiences of HIV service interruptions during the pandemic.