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

项目总结 本次艾滋病病毒/丙型肝炎病毒/新冠肺炎补充项目的目标是扩大原始研究队列以供研究(1)。 在HIV感染者(PLWH)和艾滋病人中实现消除丙型肝炎病毒的可行性和障碍 与艾滋病毒护理和预防挂钩的艾滋病毒风险(PAH)和(2)新冠肺炎大流行和 对艾滋病毒和丙型肝炎病毒的连续护理和健康结果进行锁定。最初的研究队列包括艾滋病毒- 2003年至2014年，感染艾滋病毒的男子在一家大型多地点社区卫生中心接受艾滋病毒初级保健。在……里面 在这个补充项目中，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 PLWH和PARH分别在该诊所接受艾滋病毒护理或艾滋病毒暴露前预防(PrEP) 社区卫生中心，如妇女、变性妇女/男子和农村居民。此外，我们还将 将研究地点扩展到包括大型多医院医疗保健系统，我的实验室利用该系统建立了 通过NIMHD支持的正在进行的新冠肺炎补充项目建立正式的研究伙伴关系。艾滋病病毒 社区卫生中心和医疗保健系统的诊所位于巴尔的摩市区和郊区。 和马里兰州农村存在严重的健康差距，并为种族人群提供艾滋病毒护理和预防服务， 性少数群体和/或性别少数群体以及其他社会经济弱势群体。根据调查结果 根据最初的队列，我们假设(1)消除丙型肝炎病毒健康差异和疾病负担可能 通过分别从事艾滋病毒护理或预防服务，为妇女和儿童保健部实现这一目标，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。我们将表演 一项纵向回溯性队列研究，使用来自医疗记录的数据来评估各个方面 在PLWH和PARH中的丙型肝炎病毒感染和护理。首先，我们将确定相关的趋势和因素 通过监测检测、流行率、发病率、治疗开始和完成、根除和重新 在PLWH和PARH中出现病毒型丙型肝炎。所有这些与丙型肝炎病毒相关的结果衡量标准(参考 关于“消除丙型肝炎一揽子计划”)将在连续使用艾滋病毒护理或PrEP的背景下分析 以及其他与艾滋病毒相关的病毒学和免疫学参数。接下来，我们将评估艾滋病毒护理的连续性 在新冠肺炎大流行期间，分析与错过预约、实验室、 和/或处方以及利用远程保健提供艾滋病毒护理和预防服务。我们还将检查 大流行前、大流行期间和大流行后PLWH和PARH之间与HIV相关的健康结果。同样， 将对“消除丙型肝炎一揽子计划”中涉及的每一项措施进行评估，以确定 新冠肺炎封锁和艾滋病毒护理/预防服务中断对消除丙型肝炎的努力。最后，我们 将在这个多医院的医疗保健中使用正在进行的对5,600名住院新冠肺炎患者的研究队列 描述临床特征并确定与新冠肺炎发病机制、疾病相关因素的系统 感染和不感染艾滋病毒和/或丙型肝炎病毒混合感染者的严重程度和治疗结果。 项目总结

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