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

HIV 和 COVID-19 的交叉点：医疗补助数据作为队列研究的补充

• 批准号: 10642852
• 负责人: Corinne E. Joshu
• 金额: $ 74.36万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-10 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10642852
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Acute; Acute Disease; Adverse effects; Age; Alcohols; Anti-Retroviral Agents; Area; CD4 Lymphocyte Count; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; COVID-19 risk; COVID-19 screening; COVID-19 severity; Caring; Cessation of life; Cities; Clinical; Cohort Studies; Communities; Complement; Continuity of Patient Care; County; Data; Diabetes Mellitus; Diagnosis; Disease; Enrollment; Epidemic; Ethnic Origin; Future; Geographic Locations; Geography; Goals; Government; HIV; HIV diagnosis; HIV/AIDS; Health; Health Services Accessibility; Healthcare; Hepatitis C Therapy; Hospitalization; Human immunodeficiency virus test; Hyperlipidemia; Hypertension; Incidence; Inflammatory; Infrastructure; Inpatients; Intervention; Local Government; Medicaid; Medical; Mental Health; Operative Surgical Procedures; Outcome; Overdose; Persons; Pharmaceutical Preparations; Pneumonia; Policies; Population; Post-Acute Sequelae of SARS-CoV-2 Infection; Prevention; Preventive care; Preventive screening; Probability; Public Health; Race; Reporting; Risk; Risk Factors; Rural; SARS-CoV-2 infection; Screening for cancer; Services; Symptoms; Syndrome; System; Telemedicine; Testing; Time; United States; Viral; Viral Load result; Visit; Washington; Work; acute care; adverse outcome; behavioral health; beneficiary; combat; comorbidity; comparison group; coronavirus disease; geographic difference; health care service utilization; high risk; improved; interest; pandemic disease; pandemic impact; pre-exposure prophylaxis; regional difference; remote health care; screening; severe COVID-19; sex; social health determinants; uptake

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.

抽象的 2019年冠状病毒病（Covid-19）大流行对人们的生活产生了前所未有的影响 全世界。然而，对艾滋病毒（PLWH）的人的影响尚不清楚。新兴证据表明 PLWH具有相似或适度的Covid-19风险，而Covid-19的风险更高 结果，包括住院和死亡。但是，数据混合在一起，因为几项研究已经 建议在临床结局上没有差异。几项研究还发现，结果在 那些没有病毒抑制和CD4计数较低的人，强调了持续艾滋病毒的重要性 关心。然而，早期的报告表明，Covid-19已破坏了整个HIV护理连续性的服务。作为 大流行继续展开，至关重要的是，更好地表征互联与结果之间的关系 在PLWH中。此外，我们需要确定大流行和公共卫生策略如何战斗 大流行影响了对PLWH的护理，以及任何不良影响是否持久。 大约40％的PLWH招收了医疗补助。拟议的项目将包括医疗补助受益人 来自2018年至2024年之间的27个州和华盛顿特区，保守估计为2500万 受益人和275,000 PLWH每年招收。医疗补助是艾滋病毒队列的重要补充 研究为我们提供了数据广度，以评估按地理位置，社会决定因素评估差异 在社区层面以及重要的子人群中的健康状况。我们将评估关系 在HIV和Covid-19疾病之间，包括由于19和不良状况而导致的住院治疗 由于Covid之类的COVID，COVID-19（PASC）。我们还将评估COVID19的影响 关于预防艾滋病毒和艾滋病毒护理的护理的大流行。我们将评估整个艾滋病毒护理的护理 连续性包括准备处方，艾滋病毒测试和年度艾滋病毒护理访问，病毒负荷测试和ARV 用药比率。我们还将评估对非HIV条件提供护理的影响， 包括年度健康访问，预防性筛查和健康状况管理。我们将比较 在前期（2001-2019），急性共同时期（2020-2021）和急性后共vid期间的护理率 周期（2022-2024）总体和地理位置（州，城市/农村，地方政府地区[LGA]， 最小的政府地区，例如县，城市，城镇等）以及COVID-19案件的区域严重程度和COVID- 19个政策。拟议的研究的发现将有助于告知和针对干预措施以改善护理 将来的PLWH。