RCMI@Morgan: Center for Urban Health Disparities Research and Innovation

项目摘要 与艾滋病毒和丙型肝炎病毒类似，引起COVID-19的SARS-CoV-2对 健康差距人口（HDP）。然而，我们假设COVID-19可能会导致健康差异， 不同的HDP之间的差异（即“内部差异”）以及某些情况和决定因素可能有助于 并预测“内部差异”。我们与多医院医疗保健系统和 多点社区卫生中心的艾滋病毒/HCV相关的健康差异的研究提供了一个立即， 研究COVID-19对健康结果和医疗服务获得的影响的实用和相关平台 以及在不同HDP人群中的利用。卫生保健系统的医院和诊所 社区保健中心位于城市、郊区和农村地区，保健差距很大。的 医疗保健系统提供了SARS-CoV-2检测服务，并治疗了许多住院的COVID-19 患者社区卫生中心为种族/民族和性/性别少数群体提供艾滋病毒护理 和其他弱势群体。我们将利用正在进行的合作伙伴关系， 队列研究设计，数据来自医疗记录，以剖析COVID-19造成的“内部差异”。 首先，我们将描述住院患者中COVID-19的临床特征和自然史， 确定与COVID-19发病机制、疾病严重程度和治疗有效性相关的因素。 我们还旨在建立新颖、独特和定制的临床“评分”系统/模型， 不同HDP患者的COVID-19结局和严重程度。其次，我们将分析和 SARS-CoV-2检测的特征，并评估HDP人群是否在 试验.我们还将分析与受试者中SARS-CoV-2阳性相关的因素。对于那些 我们将评估他们参与/参与COVID-19级联护理的情况， 确定与参加或错过护理级联中每个阶段相关的因素。接下来我们就 评估COVID-19封锁期间的艾滋病毒连续护理，分析相关趋势和因素 缺少预约、实验室和/或处方以及远程保健的利用。我们亦会研究 在封锁期间继续护理的人中与艾滋病毒相关的健康结果。最后，我们将表演 问卷调查或访谈，以评估（1）COVID-19患者护理的经验和看法 来自一线医疗保健工作者和（2）艾滋病毒患者的艾滋病毒护理远程医疗的利弊 和护理提供者。我们还将评估COVID-19大流行如何改变/塑造了人们的看法， 住院医师、实习医生和学生的职业/专业选择。这个项目的结果将有助于 减少HDP中COVID-19造成的健康差异。 项目摘要

PROJECT SUMMARY Similar to HIV and hepatitis C virus, SARS-CoV-2, the cause of COVID-19, is most devastating to people of health disparity populations (HDP). However, we hypothesize that COVID-19 could cause health disparities among different HDP (i.e. “disparities within”) and certain circumstances and determinants could contribute to and predict the “disparities within”. Our ongoing partnerships with a multi-hospital healthcare system and a multisite community health center for the study of HIV/HCV-related health disparities provide an immediate, practical, and pertinent platform to study the impacts of COVID-19 on health outcomes and healthcare access and utilization among people of various HDP. The hospitals of the healthcare system and the clinics of the community health center are situated in urban, suburban, and rural areas with major health disparities. The healthcare system has provided SARS-CoV-2 testing services and treated many hospitalized COVID-19 patients. The community health center provides HIV care to people of racial/ethnic and sexual/gender minorities and other vulnerable populations. We will take advantage of the ongoing partnerships, using a retrospective cohort study design with data from the medical records, to dissect the “disparities within” caused by COVID-19. First, we will delineate the clinical features and natural history of COVID-19 among the hospitalized patients, and determine the factors associated with COVID-19 pathogenesis, disease severity, and treatment effectiveness. We also aim to establish novel, unique, and tailored clinical “scoring” systems/models that can be used to predict COVID-19 outcomes and severity in patients of different HDP. Second, we will analyze the trends in and characteristics of the SARS-CoV-2 testing and assess whether people of the HDP were underrepresented in the testing. We will also analyze the factors associated with SARS-CoV-2 positivity among those tested. For those who tested positive, we will assess their participation/engagement in the COVID-19 cascade of care and determine the factors associated with attending or missing each of the stages in the care cascade. Next, we will assess the HIV continuum of care during the COVID-19 lockdown, analyzing the trends and factors associated with missing appointments, labs, and/or prescriptions as well as the utilization of telehealth. We will also examine the HIV-related health outcomes among those who continued care during the lockdown. Finally, we will perform questionnaire surveys or interviews to assess the experiences and perceptions of (1) COVID-19 patient care from the frontline healthcare workforce and (2) the pros and cons of telehealth in HIV care from the HIV patients and care providers. We will also evaluate how the COVID-19 pandemic has changed/shaped the perception and career/specialty choice of the medical residents, interns, and students. The results from this project will help reduce the health disparities caused by COVID-19 among the HDP. PROJECT SUMMARY