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

RCMI@摩根：城市健康差异研究与创新中心

• 批准号: 10452009
• 负责人: Valerie Odero-Marah
• 金额: $ 27.16万
• 依托单位: MORGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-31 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10452009
• 关键词: 2019-nCoV; Address; Adult; African American; Antiviral Agents; Appointment; Baltimore; CD4 Lymphocyte Count; COVID-19; COVID-19 outbreak; COVID-19 pandemic; COVID-19 pathogenesis; COVID-19 patient; COVID-19 severity; Caring; Cessation of life; Characteristics; Chronic Hepatitis C; Clinic; Clinic Visits; Clinical; Cohort Studies; Communities; Continuity of Patient Care; Data; Drug user; Epidemic; Evaluation; Frequencies; Gender; Goals; HIV; HIV diagnosis; HIV/HCV; Health; Health Services Accessibility; Healthcare; Healthcare Systems; Hepatitis C; Hepatitis C Acquisition; Hepatitis C Incidence; Hepatitis C Prevalence; Hepatitis C co-infection; Hepatitis C virus; Hospitals; Immunologics; Incidence; Infection; Interferons; Interruption; Lesbian Gay Bisexual Transgender Intersex; Liver; Liver Fibrosis; Liver diseases; Maryland; Measures; Mechanical Ventilators; Medical Records; Minority; Minority Groups; Monitor; Neighborhood Health Center; Outcome; Outcome Measure; Patients; Prevalence; Prevention; Preventive care; Preventive service; Primary Health Care; Research; Research Design; Retrospective cohort; Retrospective cohort study; Risk; Rural; Services; Severities; Severity of illness; Site; Testing; Time; Time trend; Treatment outcome; Viral; Viral Load result; Viremia; Virus; Woman; base; black men; burden of illness; care systems; cohort; community clinic; disadvantaged population; gender minority; health disparity; health disparity populations; high risk sexual behavior; injection drug use; innovation; men; men who have sex with men; minority disparity; minority health; multiple drug use; older men; pandemic disease; parent project; pre-exposure prophylaxis; primary care setting; racial disparity; racial minority; rural area; rural dwellers; sexual minority; social health determinants; socioeconomic disadvantage; suburb; telehealth; transgender women; transmission process; trend; trend analysis; uptake; urban health disparities; virology; young man

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

项目摘要 此HIV/HCV/COVID-19补充项目的目的是扩展原始研究队列的研究（1） 在艾滋病毒（PLWH）和人民中实现HCV消除HCV的可行性和障碍 通过与艾滋病毒护理和预防联系连接艾滋病毒的风险（PARH）以及（2）COVID-19-19和 对艾滋病毒和HCV护理和健康成果的连续性的锁定。最初的研究队列包括HIV- 从2003年到2014年，在一个大型多站点社区健康中心从事HIV初级保健的被感染男性。 这个补充项目，我们将从2014年将研究队列扩展到2024年，并包括其他少数民族 PLWH和PARH接受HIV护理或HIV前预防（PREP）（PREP）的PLWH和PAR 社区卫生中心，例如妇女，跨性别女性/男性和粗糙的居民。此外，我们将 扩展研究地点以包括一个大型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补充项目的正式研究合作伙伴关系。艾滋病毒 社区健康中心和医疗保健系统的诊所位于城市和巴尔的摩郊区 以及马里兰州具有重大健康差异的马里兰州，并为种族患者提供艾滋病毒护理和预防服务， 性和/或性别少数群体以及其他社会经济处境不利的人群。根据发现 从最初的队列中，我们假设（1）消除HCV健康差异和疾病伯恩斯可能 通过分别从事艾滋病毒护理或预防服务来实现PLWH和PARH，以及（2） 某些情况和决定可能会构成实现这一预期结果的障碍。我们将表演 一项纵向回顾性队列研究，其数据来自医疗记录，以评估各个方面 PLWH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 通过监视测试，患病率，事件，治疗计划和完成，消除和重新 PLWH和PARH中病毒HCV的发生。所有这些与HCV相关的结果指标 至于“ HCV消除软件包”）将在艾滋病毒护理或准备使用情况下进行分析 以及其他与HIV相关的病毒学和免疫学参数。接下来，我们将评估HIV的护理连续性 在COVID-19大流行期间，分析与缺失的任命，实验室相关的趋势和因素 和/或处方以及远程医疗用于艾滋病毒护理和预防服务的利用。我们还将检查 大流行之前，之中和之后，PLWH和PARH之间与HIV相关的健康结果。相似地， 将评估“ HCV消除套餐”中涉及的每种措施，以确定 COVID-19-lockdown和HIV护理/预防服务中断HCV消除努力。最后，我们 将在此多医院医疗保健中使用正在进行的研究队列> 5,600名住院Covid-19患者 描述临床特征并确定与199号发病机理相关的因素的系统 患有和/或HCV共感染的患者的严重程度和治疗结果。 项目摘要