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

基本信息

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
项目类别：
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

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

项目概要该 HIV/HCV/COVID-19 补充项目的目标是扩大原始研究队列的研究范围 (1) 在艾滋病毒感染者 (PLWH) 和以下人群中实现消除丙型肝炎病毒的可行性和障碍通过与 HIV 护理和预防联系起来的 HIV 风险 (PARH) 以及 (2) COVID-19 大流行的影响和封锁艾滋病毒和丙型肝炎的连续护理和健康结果最初的研究队列包括艾滋病毒- 2003 年至 2014 年期间，在一个大型多地点社区卫生中心从事艾滋病毒初级保健的男性感染者。在这个补充项目中，我们将扩大研究队列，从 2014 年到 2024 年，并包括其他少数族裔分别在该诊所的诊所接受 HIV 护理或 HIV 暴露前预防 (PrEP) 的 PLWH 和 PARH 社区卫生中心，例如妇女、跨性别妇女/男子和农村居民。扩大研究地点，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 HIV-19 补充项目建立正式的研究伙伴关系。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地区存在重大健康差距，并为不同种族、性和/或性别少数群体以及其他社会经济弱势群体。从最初的队列中，我们追求 (1) 消除 HCV 健康差异和疾病负担可以通过分别参与艾滋病毒护理或预防服务，为 PLWH 和 PARH 实现目标，以及 (2) 某些情况和决定因素可能会对实现这一预期结果构成障碍。一项纵向回顾性队列研究，使用来自医疗记录的数据来评估各个方面首先，我们将确定相关趋势和因素。监测检测、患病率、发病率、治疗开始和完成、根除和重新治疗 PLWH 和 PARH 中 HCV 病毒血症的发生率所有这些 HCV 相关结果指标（参考）（关于“HCV 消除方案”）将在 HIV 护理或 PrEP 使用连续性的背景下进行分析接下来，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、和/或处方以及利用远程医疗进行艾滋病毒护理和预防服务。在大流行之前、期间和之后，PLWH 和 PARH 中与 HIV 相关的健康结果也类似，将评估“HCV 消除计划”中涉及的每一项措施，以确定其影响 COVID-19 封锁和 HIV 护理/预防性服务中断对 HCV 消除工作的影响最后，我们。将在这个多医院医疗保健中使用由超过 5,600 名住院 COVID-19 患者组成的正在进行的研究队列系统描绘临床特征并确定与 COVID-19 发病机制、疾病相关的因素感染和未感染 HIV 和/或 HCV 合并感染者的严重程度和治疗结果。项目概要