Effects of overlapping Pandemics on Coping and behavioral Health among young adults affected by HIV (EPOCH-HIV)

COVID-19大流行极大地扰乱了许多年轻人的日常生活，包括年轻人 在成长过程中感染了围产期获得性艾滋病病毒（YAPHIV）。YAPHIV易受不良健康结果的影响 （精神疾病、物质使用、病毒抑制率低）， 艾滋病、种族主义和贫困。在围产期暴露于艾滋病毒但未感染的人（YAPHEU）在 这些人是类似的弱势群体，但往往无法获得与YAPHIV相同的服务。在R21中，我们将 研究COVID-19大流行对受影响的年轻人的应对和行为健康的影响 艾滋病毒（EPOCH-HIV），以便为解决行为健康问题和艾滋病毒的护理和干预提供信息 治疗和预防受艾滋病毒影响的黑人和拉丁美洲青年。利用纵向资源 YAPHIV和YAPHEU队列（CASAH; R 01-MH 69133），以及我们与东北/加勒比地区的合作 艾滋病教育和培训中心（NECA AETC），我们将告知量身定制的行为和身体健康 在艾滋病毒和COVID-19大流行重叠的时代，提供服务以满足受艾滋病毒影响的青年人的需求。 CASAH收集了关于YAPHIV和YAPHEU的广泛的社会心理，精神病学和行为数据， 从2003年（n=340;平均年龄12岁）到现在（平均年龄27岁）的健康结果（包括HIV结果） 年）。为了实现EPOCH-HIV的目标，我们将使用潜在类别分析（LCA）（目标1）来识别大流行 经验类型学（即，受影响程度（严重影响、中度影响、轻微影响） 心理社会因素的变化（例如，工作/住房损失、创伤）。然后我们将探讨风险和保护因素 对于这些类型学（例如，种族/民族、性别、PHIV状况、社会支持）以及 流行病经历类型学和以下结果：（a）行为健康（即，精神健康，物质 使用），（B）疫苗和加强剂摄取，c）身体健康（例如，身体质量指数、保健访问），以及（d） YAPHIV病毒抑制。从这些类型的参与者中取样，我们将定性地研究 在COVID-19大流行之前和期间的生活经验（目标2），以确定（a）中需要修改的领域 行为健康（B）疫苗和加强剂的摄取，和（c）身体健康，和（d）YAPHIV护理。我们 多学科团队在传染病，COVID-19，心理健康，YA，围产期艾滋病毒， 定性方法，移动健康， 结构性种族主义、创伤、心理社会和行为干预 发展，并在一起进行这项工作的独特定位。公共卫生影响：EPOCH将使用 严格和创新的方法，以确定并开始解决COVID-19大流行如何影响 行为和身体健康以及对受艾滋病毒影响的青年人的护理。我们与NECA AETC和领导人的合作关系 将使我们能够接触到提供者，迅速传播研究结果，并为定制 服务，以解决NIH OAR的优先事项：1）减少艾滋病毒发病率和治疗的健康差距 结果，2）解决艾滋病毒合并症，3）产生实质性的研究到实践的临床影响。

The COVID-19 pandemic has dramatically disrupted everyday life for many young people, including young adults who have grown up with perinatally-acquired HIV (YAPHIV). YAPHIV were vulnerable to poor health outcomes (mental illness, substance use, low rates of viral suppression) before the pandemic due to the multifaceted impact of HIV, racism, and poverty. YA who were perinatally HIV-exposed, but uninfected (YAPHEU) have grown up in similar vulnerable communities, but often without the same access to services as YAPHIV. In this R21, we will examine the Effects of the COVID-19 Pandemic On Coping and behavioral Health among young adults affected by HIV (EPOCH-HIV) in order to inform care and interventions that address behavioral health problems and HIV treatment and prevention for Black and Latinx YA affected by HIV. Leveraging resources from a longitudinal cohort of YAPHIV and YAPHEU (CASAH; R01-MH69133), and our collaboration with the Northeast/Caribbean AIDS Education and Training Center (NECA AETC), we will inform the tailoring of behavioral and physical health services to meet the needs of YA affected by HIV in an era of overlapping HIV and COVID-19 pandemics. CASAH has collected extensive psychosocial, psychiatric, and behavioral data on YAPHIV and YAPHEU, and health outcomes (including HIV outcomes) from 2003 (n=340; mean age 12 years) to the present (mean age 27 years). To achieve EPOCH-HIV’s aims, we will use latent class analysis (LCA) (Aim 1) to identify pandemic experience typologies (i.e., highly affected, moderately affected, minimally affected) based on pandemic-related changes to psychosocial factors (e.g., job/housing loss, trauma). We will then explore risk and protective factors for these typologies (e.g., race/ethnicity, gender, PHIV status, social support) as well as the relationship between pandemic experience typologies and the following outcomes: (a) behavioral health (i.e., mental health, substance use), (b) vaccine and booster uptake, c) physical health (e.g., body mass index, health care visits), and (d) YAPHIV viral suppression. Sampling from participants in each of these typologies, we will qualitatively examine lived experiences before and during the COVID-19 pandemic (Aim 2), to identify areas for modification in (a) behavioral health (b) vaccine and booster uptake, and (c) physical health, and (d) YAPHIV care. Our multidisciplinary team has expertise in infectious diseases, COVID-19, mental health, YA, perinatal HIV, qualitative methods, mHealth, structural racism, trauma, and psychosocial and behavioral intervention development, and together are uniquely positioned to conduct this work. Public Health Impact: EPOCH will use rigorous and innovative methods to identify and begin to address how the COVID-19 pandemic affected the behavioral and physical health and care for of YA affected by HIV. Our partnership with NECA AETC and leaders in health services will enable us to reach providers and rapidly disseminate findings and inform the tailoring of services to address the NIH OAR priorities of: 1) reducing health disparities in HIV incidence and treatment outcomes, 2) addressing HIV co-morbidities, 3) making a substantive research-to-practice clinical impact.