Addressing community-level influences of HIV and COVID-19 disparities among people with HIV

FIU-RCMI研究项目#3 摘要 人类免疫缺陷病毒和新冠肺炎这两大流行病有着惊人的相似之处 尊重发病率和死亡率方面的种族/族裔和社会经济差异。结构战略： 艾滋病毒和新冠肺炎的成果可以通过以下方式加强当前基于代理人的(个人层面)干预 解决限制个人降低风险的能力的因素，以及解决问题的传播 在以代理人为基础的干预措施不易接触到的人群中。本研究的主要目的是：(A) 确定社区层面对艾滋病毒的性别、种族/民族和城乡差异的可改变影响 和(B)在艾滋病毒感染者中制定政策和方案 解决这些社区层面影响的建议。拟议的研究将使用个人层面的 2017-2023年佛罗里达州艾滋病毒/艾滋病监测数据与个人层面2020-2023年佛罗里达州新冠肺炎 监控数据。关联的艾滋病毒和新冠肺炎数据将与另外10个人口普查地区和县合并- 佛罗里达州的社区数据水平。使用复杂的分析方法，并以生态社会理论为指导 和国家少数民族健康与健康差距研究所的研究框架，我们建议 检查在5个影响领域影响健康差距的社区因素：(1)生物因素，(2) 行为，(3)物理/建筑环境，(4)社会文化环境，(5)卫生保健系统。 此外，拟议的研究将召集佛罗里达州艾滋病毒领导人的战略规划工作组，以 提出建议，以解决艾滋病毒的社区影响和人与人之间的新冠肺炎差距 艾滋病毒携带者。我们提出了三个具体目标：目标1.估计社区因素对社区健康的调节作用 性别、种族/民族和城乡居住地之间的联系以及两者的差异(来自冠状病毒感染前- 19[2017-2019年]新冠肺炎大流行的急性期[2020年])和轨迹(从新冠肺炎爆发前开始 [2017-2019年]通过新冠肺炎大流行的演变时期[2020年-2023年]) 艾滋病毒携带者。目的2.评估社区因素对人际关系的调节作用 性别、种族/族裔、城乡居民和新冠肺炎成果在急性时期(2020年)和 在艾滋病毒携带者中演变的(2020年至2023年)新冠肺炎大流行时期。目标3.制定政策和 针对性别、种族/民族和农村/城市社区影响的方案建议 艾滋病毒携带者之间艾滋病毒和新冠肺炎结果的差异。这项研究的结果将提供一个 社区背景对新冠肺炎的影响和艾滋病患者中艾滋病毒差异的新理解 艾滋病毒，以及制定一项可行的计划，以保护艾滋病毒携带者的弱势群体，并提供支持 新冠肺炎时代结束艾滋病毒流行的目标。这项研究进一步支持美国国立卫生研究院2021-2025年的 研究艾滋病毒合并症和综合征的优先研究领域，并侧重于社区和社会- 影响艾滋病毒结果不平等的结构性因素。

FIU-RCMI Research Project #3 Abstract The twin pandemics of human immunodeficiency virus (HIV) and COVID-19 share uncanny similarities with respect to racial/ethnic and socioeconomic disparities in both incidence and mortality. Structural strategies for HIV and COVID-19 outcomes could augment current agent-based (individual-level) interventions by addressing those factors that limit a person's ability to carry out risk reduction, as well as address transmission among people not easily reached by agent-based interventions. The primary objectives of this study are: (a) to identify modifiable community-level influences on gender, racial/ethnic, and rural/urban disparities in HIV and COVID-19 outcomes among people with HIV; and (b) to develop policy and programmatic recommendations to address these community-level influences. The proposed study will use individual-level 2017-2023 Florida HIV/AIDS surveillance data linked to individual-level 2020-2023 Florida COVID-19 surveillance data. Linked HIV and COVID-19 data will be merged with 10 additional census tract- and county- level community data for Florida. Using a mix of complex analytical approaches and guided by ecosocial theory and the National Institute on Minority Health and Health Disparities research framework, we propose to examine community factors that impact health disparities across 5 domains of influence: (1) biological, (2) behavioral, (3) physical/built environment, (4) sociocultural environment, and (5) health care system. Additionally, the proposed study will convene a strategic planning workgroup of HIV leaders across Florida to develop recommendations to address community influences of HIV and COVID-19 disparities among people with HIV. We propose three specific aims: Aim 1. Estimate the moderating effect of community factors on the association between gender, race/ethnicity, and rural/urban residence and both differences (from pre-COVID- 19 [2017-2019] to the acute period of the COVID-19 Pandemic [2020]) and trajectories (from pre-COVID-19 [2017-2019] through the evolving periods of the COVID-19 Pandemic [2020-2023]) in HIV outcomes among people with HIV. Aim 2. Estimate the moderating effect of community factors on the association between gender, race/ethnicity, and rural/urban residence and COVID-19 outcomes during the acute (2020) and evolving (2020-2023) periods of the COVID-19 Pandemic among people with HIV. Aim 3. Develop policy and programmatic recommendations to address community influences of gender, racial/ethnic, and rural/urban disparities in HIV and COVID-19 outcomes among people with HIV. Findings from this study will provide a novel understanding of the impact of community context on COVID-19 and HIV disparities among people with HIV, as well as develop an actionable plan to protect vulnerable populations of people with HIV and support the goals of Ending the HIV Epidemic in the COVID-19 era. This study further supports NIH's 2021-2025 research priority areas of studying HIV comorbidities and syndemics, and of focusing on community and social- structural factors influencing inequities in HIV outcomes.