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Principal Investigator: Diana Montserrat Sheehan
Organization: FLORIDA INTERNATIONAL UNIVERSITY
Fiscal Year: 2022
Award: $354,222
Funding agency: National Institute on Minority Health and Health Disparities
FIU-RCMI Research Project #3
Abstract
The twin pandemics of human immunodeficiency virus (HIV) and COVID-19 share uncanny similarities with
respect to racial/ethnic and socioeconomic disparities in both incidence and mortality. Structural strategies for
HIV and COVID-19 outcomes could augment current agent-based (individual-level) interventions by
addressing those factors that limit a person's ability to carry out risk reduction, as well as address transmission
among people not easily reached by agent-based interventions. The primary objectives of this study are: (a)
to identify modifiable community-level influences on gender, racial/ethnic, and rural/urban disparities in HIV
and COVID-19 outcomes among people with HIV; and (b) to develop policy and programmatic
recommendations to address these community-level influences. The proposed study will use individual-level
2017-2023 Florida HIV/AIDS surveillance data linked to individual-level 2020-2023 Florida COVID-19
surveillance data. Linked HIV and COVID-19 data will be merged with 10 additional census tract- and county-
level community data for Florida. Using a mix of complex analytical approaches and guided by ecosocial theory
and the National Institute on Minority Health and Health Disparities research framework, we propose to
examine community factors that impact health disparities across 5 domains of influence: (1) biological, (2)
behavioral, (3) physical/built environment, (4) sociocultural environment, and (5) health care system.
Additionally, the proposed study will convene a strategic planning workgroup of HIV leaders across Florida to
develop recommendations to address community influences of HIV and COVID-19 disparities among people
with HIV. We propose three specific aims: Aim 1. Estimate the moderating effect of community factors on the
association between gender, race/ethnicity, and rural/urban residence and both differences (from pre-COVID-
19 [2017-2019] to the acute period of the COVID-19 Pandemic [2020]) and trajectories (from pre-COVID-19
[2017-2019] through the evolving periods of the COVID-19 Pandemic [2020-2023]) in HIV outcomes among
people with HIV. Aim 2. Estimate the moderating effect of community factors on the association between
gender, race/ethnicity, and rural/urban residence and COVID-19 outcomes during the acute (2020) and
evolving (2020-2023) periods of the COVID-19 Pandemic among people with HIV. Aim 3. Develop policy and
programmatic recommendations to address community influences of gender, racial/ethnic, and rural/urban
disparities in HIV and COVID-19 outcomes among people with HIV. Findings from this study will provide a
novel understanding of the impact of community context on COVID-19 and HIV disparities among people with
HIV, as well as develop an actionable plan to protect vulnerable populations of people with HIV and support
the goals of Ending the HIV Epidemic in the COVID-19 era. This study further supports NIH's 2021-2025
research priority areas of studying HIV comorbidities and syndemics, and of focusing on community and social-
structural factors influencing inequities in HIV outcomes.
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fatality><COVID-19 induced mortality><COVID-19 infection><COVID-19 mortality><COVID-19 pandemic><COVID-19 public health crisis><COVID-19 related death><COVID-19 related disparity><COVID-19 related fatality><COVID-19 related mortality><COVID-19 surveillance><COVID-19 virus><COVID19><COVID19 associated death><COVID19 associated fatality><COVID19 associated mortality><COVID19 crisis><COVID19 death><COVID19 diagnosis><COVID19 disparity><COVID19 epidemic><COVID19 fatality><COVID19 global health crisis><COVID19 global pandemic><COVID19 health crisis><COVID19 induced death><COVID19 induced fatality><COVID19 induced mortality><COVID19 infection><COVID19 mortality><COVID19 pandemic><COVID19 public health crisis><COVID19 related death><COVID19 related fatality><COVID19 related mortality><COVID19 surveillance><COVID19 virus><CV-19><CV19><California><Caring><Case Fatality Rates><Censuses><Chronic><CoV-2><CoV2><Communities><Complex><County><Data><Data Science><Data 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inequity><socioeconomically><socioeconomics><sociostructural><studies of populations><study of the population><surveillance data><syndemic><synergistic epidemic><theories><transmission process><treatment access><urban disparity><urban residence><vulnerable group><vulnerable people>