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Principal Investigator: Corinne E. Joshu
Organization: JOHNS HOPKINS UNIVERSITY
Fiscal Year: 2024
Award: $776,684
Funding agency: National Institute of Allergy and Infectious Diseases
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.
Terms: <AIDS><AIDS Virus><AIDS prevention><AIDS test><AIDS/HIV><AIDS/HIV test><Access to Care><Acquired Immune Deficiency><Acquired Immune Deficiency Syndrome><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome><Acquired Immunodeficiency Syndrome Virus><Acute><Acute Disease><Adverse effects><Age><Alcohol Chemical Class><Alcohols><Anti-Retroviral Agents><Area><CD4 Lymphocyte Count><CD4+ Cell Counts><CD4+ Counts><COVID crisis><COVID disease severity><COVID epidemic><COVID pandemic><COVID screening><COVID severity><COVID-19><COVID-19 affected><COVID-19 consequence><COVID-19 crisis><COVID-19 disease severity><COVID-19 effect><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 impact><COVID-19 impacted><COVID-19 infection><COVID-19 pandemic><COVID-19 pandemic affected><COVID-19 pandemic consequence><COVID-19 pandemic effects><COVID-19 pandemic impact><COVID-19 pandemic impacted><COVID-19 period><COVID-19 public health crisis><COVID-19 related risk><COVID-19 risk><COVID-19 risk factor><COVID-19 screening><COVID-19 severity><COVID-19 virus infection><COVID-19 years><COVID19 disease severity><COVID19 infection><COVID19 screening><COVID19 severity><CV-19><Caring><Cessation of life><Cities><Clinical><Cohort Studies><Communities><Complement><Complement Proteins><Concurrent Studies><Continuity of Care><Continuity of Patient Care><Continuum of Care><Coronavirus Infectious Disease 2019><County><Data><Death><Diabetes Mellitus><Diagnosis><Disease><Disorder><Drugs><Enrollment><Epidemic><Ethnic Origin><Ethnicity><Future><Geographic Area><Geographic Locations><Geographic Region><Geographical Location><Geography><Goals><Government><HCV therapy><HCV treatment><HIV><HIV Prevention><HIV diagnosis><HIV test><HIV-1 test><HIV-2 test><HIV/AIDS><HIV/AIDS prevention><Health><Health Care Utilization><Health Services Accessibility><Healthcare><Hepatitis C Therapeutics><Hepatitis C Therapy><Hepatitis C Virus Treatment><Hepatitis C treatment><Hospital Admission><Hospitalization><Human Immunodeficiency Viruses><Human immunodeficiency virus test><Hyperlipemia><Hyperlipidemia><Hypertension><Incidence><Inflammatory><Infrastructure><Inpatients><Intervention><Intervention Strategies><LAV-HTLV-III><Local Government><Long COVID><Long COVID-19><Long coronavirus disease><Long coronavirus disease 2019><Lymphadenopathy-Associated Virus><Medicaid><Medical><Medication><Mental Health><Mental Hygiene><Operative Procedures><Operative Surgical Procedures><Outcome><Overdose><PASC><Persons><Pharmaceutical Preparations><Pneumonia><Policies><Population><Post Acute Sequelae of COVID19><Post Acute Sequelae of SARS-CoV-2><Post Acute Sequelae of SARS-CoV2><Post Acute Sequelae of severe acute respiratory syndrome coronavirus 2><Post-Acute Sequelae of SARS-CoV-2 Infection><PrEP><Preventative care><Preventative screening><Prevention><Preventive care><Preventive screening><Probability><Psychological Health><Public Health><Race><Races><Reporting><Risk><Risk Factors><Rural><SARS-CoV-2 disease severity><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 infection><SARS-CoV-2 pandemic><SARS-CoV-2 screening><SARS-CoV-2 severity><SARS-CoV2 infection><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Screening for cancer><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 infection><Severe acute respiratory syndrome coronavirus 2 pandemic><Surgical><Surgical Interventions><Surgical Procedure><Symptoms><Syndrome><System><T4 Lymphocyte Count><Telemedicine><Testing><Time><United States><Vascular Hypertensive Disease><Vascular Hypertensive Disorder><Viral><Viral Burden><Viral Load><Viral Load result><Virus-HIV><Visit><Washington><Well visit><Work><access to health services><access to services><access to treatment><accessibility to health services><acute COVID-19><acute SARS-CoV-2 infection><acute care><acute disease/disorder><acute disorder><acute phase of COVID-19><acute phase of SARS-CoV-2 infection><adverse consequence><adverse outcome><adverse sequelae of COVID><adverse sequelae of COVID-19><adverse sequelae of coronavirus disease><adverse sequelae of coronavirus disease 2019><ages><anti-retroviral><availability of services><behavioral health><beneficiary><care access><chronic COVID><chronic COVID-19><chronic COVID-19 sequelae><chronic effect of COVID-19><chronic novel coronavirus disease 2019><co-morbid><co-morbidity><combat><comorbidity><comparator group><comparison group><complementation><coronavirus disease 2019><coronavirus disease 2019 consequence><coronavirus disease 2019 crisis><coronavirus disease 2019 disease severity><coronavirus disease 2019 effect><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 impact><coronavirus disease 2019 infection><coronavirus disease 2019 pandemic><coronavirus disease 2019 pandemic consequence><coronavirus disease 2019 pandemic impact><coronavirus disease 2019 public health crisis><coronavirus disease 2019 risk><coronavirus disease 2019 risk factor><coronavirus disease 2019 screening><coronavirus disease 2019 severity><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease screening><coronavirus disease severity><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 impact><coronavirus disease-19 pandemic><coronavirus infectious disease-19><coronavirus screening><diabetes><drug/agent><early cancer detection><effects following the COVID-19 pandemic><enroll><geographic difference><geographic site><geographic variation><health care><health care service use><health care service utilization><health service access><health services availability><healthcare service use><healthcare service utilization><healthcare utilization><high blood pressure><high risk><hyperpiesia><hyperpiesis><hypertensive disease><hypertensive disorder><impact of the SARS-CoV-2 pandemic><improved><infected with COVID-19><infected with COVID19><infected with SARS-CoV-2><infected with SARS-CoV2><infected with coronavirus disease 2019><infected with severe acute respiratory syndrome coronavirus 2><interest><interventional strategy><life-threatening COVID><life-threatening COVID-19><life-threatening SARS-CoV-2><life-threatening coronavirus disease><life-threatening coronavirus disease 2019><life-threatening severe acute respiratory syndrome coronavirus 2><long haul COVID><long haul COVID-19><long haul coronavirus disease><long haul coronavirus disease 2019><long haul sequelae of COVID-19><long haul sequelae of coronavirus disease 2019><long term consequences of COVID-19><long term consequences of SARS-CoV-2 infection><long term consequences of coronavirus disease-19><long term effects of COVID-19><long term health consequences of COVID-19><long term health consequences of SARS-CoV2 infection><long term impact of COVID-19><long term impact of SARS-CoV-2 infection><long-hauler COVID><long-hauler COVID-19><long-hauler coronavirus disease 2019><long-hauler syndrome><long-term COVID><long-term COVID-19><long-term consequence of severe acute respiratory distress syndrome-cov-2 infection><long-term coronavirus disease><long-term coronavirus disease 2019><long-term effects of coronavirus disease-19><long-term sequelae of COVID-19><long-term sequelae of SARS-CoV-2><long-term sequelae of coronavirus disease 2019><long-term sequelae of severe acute respiratory syndrome coronavirus 2><longterm COVID><longterm COVID-19><longterm consequences of COVID-19><longterm consequences of SARS-CoV-2 infection><longterm coronavirus disease><longterm coronavirus disease 2019><longterm effects of COVID-19><longterm health consequences of COVID-19><longterm health consequences of SARS-CoV2 infection><longterm impact of COVID-19><longterm impact of SARS-CoV-2 infection><pandemic><pandemic disease><pandemic effect><pandemic impact><pandemic outcome><pandemic repercussions><persistent COVID-19><post COVID syndrome><post COVID-19 sequelae><post COVID-19 syndrome><post acute COVID syndrome><post acute COVID-19><post acute COVID-19 syndrome><post acute SARS-CoV-2><post acute coronavirus disease 2019><post acute coronavirus disease 2019 syndrome><post acute coronavirus disease syndrome><post acute sequelae following COVID-19><post acute severe acute respiratory syndrome coronavirus 2><post coronavirus disease 2019 syndrome><post coronavirus disease syndrome><post-acute phases of COVID-19><post-acute sequelae following SARS-CoV-2 infection><post-acute sequelae of COVID-19><post-acute sequelae of acute COVID infection><post-acute sequelae of coronavirus disease 2019><pre-exposure prophylaxis><prolonged COVID-19 symptoms><racial><racial background><racial origin><regional difference><remote care><remote health care><remote healthcare><risk associated with COVID-19><risk factor associated with COVID-19><risk factor related to COVID-19><risk related to COVID-19><screening><screening cancer patients><screenings><serious COVID><serious COVID-19><serious SARS-CoV-2><serious coronavirus disease><serious coronavirus disease 2019><serious severe acute respiratory syndrome coronavirus 2><service availability><severe COVID><severe COVID-19><severe COVID19><severe SARS-CoV-2><severe acute respiratory syndrome coronavirus 2 disease severity><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><severe acute respiratory syndrome coronavirus 2 screening><severe acute respiratory syndrome coronavirus 2 severity><severe coronavirus disease><severe coronavirus disease 19><severe coronavirus disease 2019><severe severe acute respiratory syndrome coronavirus 2><sex><social health determinants><surgery><treatment access><uptake><wellness exam><wellness examination><wellness visit>