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

项目摘要 这个HIV/HCV/COVID-19补充项目的目标是扩大最初的研究队列，以研究（1） 在艾滋病毒感染者（PLWH）和艾滋病患者中实现消除HCV的可行性和障碍 通过与艾滋病毒护理和预防的联系，降低艾滋病毒（PARH）的风险，以及（2）COVID-19大流行的影响， 锁定艾滋病毒和丙型肝炎病毒的连续护理和健康成果。最初的研究队列包括艾滋病毒- 从2003年到2014年，感染者在一个大型的多地点社区卫生中心从事艾滋病毒初级保健。在 这个补充项目，我们将扩大研究队列，从2014年到2024年，并包括更多的少数民族， 艾滋病毒感染者和PARH接受艾滋病毒护理或艾滋病毒暴露前预防（PrEP），分别在诊所， 社区保健中心，如妇女、变性妇女/男子和农村居民。此外，我们将 扩展研究地点，包括一个大型的多医院医疗保健系统，我的实验室已经建立了一个 通过正在进行的NIMHD支持的COVID-19补充项目建立正式的研究伙伴关系。艾滋病毒 社区卫生中心和卫生保健系统的诊所位于巴尔的摩市区和郊区 和农村马里兰州与主要的健康差距，并提供艾滋病毒护理和预防服务的人， 性和/或性别少数群体和其他社会经济弱势群体。根据调查结果 从最初的队列中，我们假设（1）消除HCV健康差异和疾病负担可以 分别通过从事艾滋病毒护理或预防服务，为艾滋病毒感染者和PARH实现，以及（2） 某些情况和决定因素可能对实现这一预期结果构成障碍。我们将执行 一项纵向回顾性队列研究，数据来自病历，以评估各个方面 艾滋病毒感染者和PARH中的HCV感染和护理。首先，我们将确定相关的趋势和因素 通过监测检测、患病率、发病率、治疗开始和完成、根除和再治疗， 病毒血症型HCV在PLWH和PARH中的发生率。所有这些HCV相关的结果指标（参考 至于"HCV消除包"）将在HIV护理或PrEP使用的连续性背景下进行分析 以及其他HIV相关的病毒学和免疫学参数。接下来，我们将评估艾滋病毒连续护理 在COVID-19大流行期间，分析与错过预约，实验室， 以及利用远程保健提供艾滋病毒护理和预防服务。我们亦会研究 艾滋病毒相关的健康结果之间的PLWH和PARH之前，期间和之后的大流行。同样地， 将对"消除HCV一揽子计划"中涉及的每项措施进行评估，以确定 2019冠状病毒病封锁和艾滋病毒护理/预防服务中断对消除丙型肝炎病毒的努力。最后我们 将在这个多医院医疗保健中使用正在进行的研究队列，其中包括> 5，600名住院COVID-19患者 描述临床特征并确定与COVID-19发病机制、疾病 严重程度和治疗结果之间有和没有艾滋病毒和/或丙型肝炎病毒合并感染。 项目摘要

PROJECT SUMMARY The goal of this HIV/HCV/COVID-19 supplement project is to expand the original study cohort for studying (1) the feasibility of and barriers to achieving HCV elimination among people living with HIV (PLWH) and people at risk of HIV (PARH) through linkage to HIV care and prevention and (2) the impact of COVID-19 pandemic and lockdown on HIV and HCV continuum of care and health outcomes. The original study cohort included HIV- infected men engaged in HIV primary care at a large, multisite community health center from 2003 to 2014. In this supplement project, we will expand the study cohort, from 2014 to 2024, and include additional minorities of PLWH and PARH receiving HIV care or HIV pre-exposure prophylaxis (PrEP), respectively, at the clinics of this community health center, such as women, transgender women/men, and rural dwellers. In addition, we will extend the study sites to include a large multi-hospital healthcare system, with which my lab has established a formal research partnership through the ongoing NIMHD-supported COVID-19 supplement project. The HIV clinics of the community health center and the healthcare system are situated in urban and suburban Baltimore and rural Maryland with major health disparities and provide HIV care and preventive services to people of racial, sexual, and/or gender minorities and other socioeconomically disadvantaged populations. Based on the findings from the original cohort, we hypothesize that (1) elimination of HCV health disparities and disease burdens could be achieved for the PLWH and PARH by engaging in HIV care or preventive services, respectively, and (2) certain circumstances and determinants could pose barriers to achieving this anticipated result. We will perform a longitudinal retrospective cohort study with data derived from the medical records to assess various aspects of HCV infection and care among the PLWH and PARH. First, we will determine trends and factors associated with surveillance testing, prevalence, incidence, treatment initiation and completion, eradication, and re- occurrence of viremic HCV among the PLWH and PARH. All of these HCV-related outcome measures (referred as to the “HCV elimination package”) will be analyzed in the context of continuum of HIV care or PrEP usage and other HIV-related virologic and immunologic parameters. Next, we will assess the HIV continuum of care during the COVID-19 pandemic, analyzing the trends and factors associated with missing appointments, labs, and/or prescriptions as well as utilization of telehealth for HIV care and preventive services. We will also examine the HIV-related health outcomes among the PLWH and PARH prior to, during, and after the pandemic. Similarly, each of the measures involved in the “HCV elimination package” will be assessed to determine the impact of COVID-19 lockdown and HIV care/preventive service interruption on HCV elimination endeavours. Finally, we will use the ongoing study cohort of >5,600 hospitalized COVID-19 patients in this multi-hospital health care system to delineate the clinical features and determine factors associated with COVID-19 pathogenesis, disease severity, and treatment outcomes among those with and without HIV and/or HCV coinfections. PROJECT SUMMARY