Antiretroviral therapy leads to viral suppression which not only prevents the progression of human immunodeficiency virus (HIV) infection to acquired immunodeficiency syndrome and death among people living with HIV (PLH), but also prevents the transmission of HIV. Therefore, viral suppression is one of the key indicators in the National HIV/AIDS Strategy for the United States. On March 12, 2020, the Mayor of Miami- Dade County declared a State of Emergency in the County due to the COVID-19 Public Health Emergency (PHE) and on March 25, 2020 advised all people 65 and older and those with health conditions, including immunosuppression, to stay home. These and other necessary steps to combat COVID-19 had a far-reaching impact on HIV care; most HIV medical case management sites and HIV clinicians began delivering care via telehealth or telephone, reducing the availability of in-person services. Furthermore, the ripple effects due to the loss of the tourist industry and closure of nonessential businesses have led to widespread unemployment and economic hardship within the community with 67,000 unemployment claims as of April 21st. The Ryan White Program (RWP) serves about 52% of PLH in the United States and is the provider of last resort, serving uninsured and underinsured PLH. Thus, the RWP serves among the most socioeconomically vulnerable PLH. Anecdotal reports indicate that many PLH are struggling with the COVID-19 PHE-related changes in HIV care delivery and are experiencing significant hardships such as food insecurity. The objective of this study is to characterize the COVID-19 PHE-related changes in HIV care delivery (e.g. use of telehealth and other remote modes of delivery) and any related difficulties and the COVID-19 PHE-related socioeconomic and psychosocial hardships experienced by RWP clients and assess how these have affected HIV viral suppression among RWP clients. A further objective is to compare the effects by racial/ethnic and gender groups to identify any potential inequities. To accomplish these objectives, we will interview 300 RWP clients by telephone (130 Hispanic, 100 African American, and 70 Haitians with roughly half men and half women in each group) about their HIV care and COVID-19 PHE-related socioeconomic and psychosocial stressors and compare their HIV viral loads before and after the onset of the COVID-19 PHE. This study will provide important information about how the COVID-19 PHE is impacting viral suppression among RWP clients, and the extent to which COVID-19 PHE-related stressors are novel barriers to care. Any inequitable impacts by race/ethnicity and gender will also be examined. This information is also critical, because due to the immune suppression experienced by many PLH, it is likely that social distancing measures may be needed during HIV care delivery for an extended period of time during the current pandemic.
The COVID-19 Public Health Emergency has led to important changes in how HIV care is delivered to protect people living with HIV from being exposed to the COVID-19 virus. Furthermore, because people living with HIV are more likely to have low incomes, they are particularly vulnerable to the economic hardships from the COVID-19 crisis. This supplemental study will evaluate the effects of the COVID-19-related changes in HIV care delivery and COVID-19-related economic and psychosocial hardships on viral load suppression among people living with HIV in the Miami-Dade County Ryan White Program.
