At the Intersection of HIV and COVID-19: Medicaid Data as a Complement to Cohort Studies

摘要 2019冠状病毒病（COVID-19）大流行对人们的生活产生了前所未有的影响 国际吧然而，对艾滋病毒感染者（PLWH）的影响尚不清楚。新出现的证据表明 PLWH有类似或适度更高的COVID-19感染风险，以及更高的COVID-19风险 结果，包括住院和死亡。然而，由于几项研究的结果， 提示临床结果无差异。一些研究还发现， 那些没有病毒抑制的人和那些CD 4计数较低的人，强调了持续艾滋病毒的重要性。 在乎然而，早期的报告表明，COVID-19扰乱了整个艾滋病毒护理连续体的服务。为 随着新冠疫情的持续发展，更好地描述COVID与结果之间的关系至关重要 在PLWH中。此外，我们需要确定如何应对大流行和公共卫生战略， 疫情影响了对艾滋病毒携带者的护理，以及任何不利影响是否持久。 大约40%的艾滋病毒携带者参加了医疗补助计划。该项目将包括医疗补助受益人 2018年至2024年期间，来自27个州和华盛顿特区的2500万人，保守估计为2500万人 每年有275 000名艾滋病毒携带者和艾滋病患者参加。医疗补助是艾滋病毒队列的重要补充 研究，因为它为我们提供了广泛的数据，以评估地理位置，社会决定因素 在社区一级以及重要的次级人口中，我们将评估 艾滋病毒和COVID-19疾病之间的关系，包括因COVID-19和不良状况而住院治疗 由于COVID-19（PASC）的COVID样急性后后遗症。我们还将评估COVID的影响19 艾滋病毒/艾滋病大流行病的预防和艾滋病毒护理的提供。我们将评估整个艾滋病护理领域的护理， 连续体，包括PrEP处方，HIV检测和年度HIV护理访视，病毒载量检测和ARV 药物占有率。我们还将评估对提供非艾滋病毒状况护理的影响， 包括年度健康检查、预防性筛查和健康状况管理。我们将比较 2001年至2019年的COVID前期、2020年至2021年的COVID急性期和COVID急性期后的护理率 2022-2024年期间总体和按地理位置（州、城市/农村、地方政府区域[LGA]， 最小的政府区域，如县、市、镇等）以及COVID-19病例和COVID-19的区域严重程度- 19政策拟议研究的结果将有助于提供信息和有针对性的干预措施，以改善 PLW在未来

ABSTRACT The Coronavirus Disease 2019 (COVID-19) pandemic has had an unprecedented impact on the lives of people worldwide. Yet, the effect on persons living with HIV (PLWH) is not known. Emerging evidence suggests that PLWH have a similar or modestly higher risk of COVID-19 acquisition, and higher risk for worse COVID-19 outcomes, including hospitalization and death. However, the data has been mixed as several studies have suggested no difference in clinical outcomes. Several studies also found that outcomes are worse among those without viral suppression and those with lower CD4 counts, highlighting the importance of continued HIV care. Yet, early reports suggest that COVID-19 has disrupted services across the HIV care continuum. As the pandemic continues to unfold, it is critical to better characterize the relationship between COVID and outcomes among PLWH. In addition, we need to identify how the pandemic and the public health strategies to combat the pandemic impacted the provision of care for PLWH, as well as whether any adverse effects are lasting. Approximately 40% of PLWH are enrolled in Medicaid. The proposed project will include Medicaid beneficiaries from 27 states and Washington, DC between 2018 and 2024 with a conservative estimate of 25 million beneficiaries and 275,000 PLWH enrolled annually. Medicaid is an important complement to HIV cohort studies as it affords us the breadth of data to evaluate differences by geographic location, social determinants of health at the community level, as well as among important sub-populations. We will assess the relationship between HIV and COVID-19 disease, including on hospitalization due to COVID-19 and adverse conditions due to COVID like post-acute sequala of COVID-19 (PASC). We will also evaluate the impact of the COVID19 pandemic on the provision of care for prevention of HIV and HIV care. We will assess care across the HIV care continuum including PrEP prescription, HIV testing, and annual HIV care visits, viral load tests, and ARV medication possession ratio. We will also evaluate impacts on the provision of care for non-HIV conditions, including annual wellness visits, preventive screenings and health condition management. We will compare care rates during the pre-COVID period (2001-2019), acute COVID period (2020-2021), and post-acute COVID period (2022-2024) overall and by geographic location (state, urban/rural, local government area [LGA], smallest government region e.g. county, city, town, etc.) and regional severity of COVID-19 cases and COVID- 19 policies. Findings from the proposed study will help inform and target interventions to improve care for PLWH in the future.