To determine correlates of poor vs. good HIV outcomes among people living with HIV (PLWH), researchers have focused on clinical data. Hence, there is limited understanding of non?clinical correlates and migration patterns of PLWH who have insecure (or fragmented) connections with the care system. This proposal will leverage our unique access to clinical and non?clinical data to measure HIV care outcomes and identify intervention opportunities to address insecure connection to care and poor outcomes inPLWH. Our team has individually linked data from the Enhanced HIV/AIDS Reporting System (eHARS), the national HIV surveillance database, with other public health, clinical, and criminal justice data. We use these data to conduct population?level epidemiology of over 10,000 PLWH in Marion County (Indianapolis), Indiana between 2000 and the present. We propose to link these data with social determinants of health data within the Indiana Management Performance Hub (MPH), a collaborative state government data?sharing hub. MPH data will complement our rich data repository by adding socioeconomic, household, and neighborhood characteristics, social service utilization (welfare, food stamps, etc.), and mental health data for PLWH. Given the complex intersection of social determinants of health and migration within and between counties (e.g., because of housing insecurity or discontinuity of insurance coverage), we will also investigate how migration relates to insecure care connections and poor outcomes. Our access to these data sources will permit us to focus on both social determinants of health and migration, and will provide us with the unprecedented ability (1) to investigate how these factors relate to HIV outcomes over time, and (2) to identify intervention opportunities (times and places) to improve connection to care and clinical outcomes in PLWH. The objective of our research is to investigate correlates, and opportunities for improvement, of poor HIV health outcomes in Marion County (Indianapolis), Indiana. The hypothesis is that identification of correlates of poor retention in care and of poor viral suppression will identify opportunities to improve health outcomes for PLWH who are insecurely connected to care.
We aim to (1) Analyze patterns in social services utilization among PLWH to (a) understand correlates of poor HIV outcomes and (b) identify non?clinical opportunities for intervention; (2) Determine if within?county and between?county migration patterns after diagnosis predict poor HIV care outcomes; (2a) Identify demographic, socioeconomic, life?course, and contextual factors associated with worse HIV outcomes among those who migrate; and (3) Develop a model to extend the utility of eHARS data for longitudinal research and public health practice, with guidance from a stakeholder advisory panel. Results from this project will inform a subsequent R01 application assessing whether supplemental wrap?around and outreach services for those identified at higher risk due to non?clinical service utilization and migration patterns improve care and outcomes of PLWH.
Because existing studies of correlates of poor versus good HIV?related outcomes are heavily based on clinical data, there is limited scientific and public policy understanding regarding people living with HIV (PLWH) who have insecure connection with the clinical care system and/or with supporting social services. We intend to enrich our existing data repository on a longitudinal cohort of over 10,000 PLWH by adding demographic, socioeconomic, household, and neighborhood characteristics, social service utilization, and mental health data obtained from multiple sources, in order to conduct population?level epidemiology, including a specific focus on migration within, into, and out of a mid?sized metropolitan county. Using a generalizable data platform, we will know when, where, and how best to intervene in the care of PLWH, particularly those who are insecurely connected to health care; consequently, the long?term impact of this project will be to improve the care and outcomes of PLWH.
