It is not clear whether the coronavirus (COVID-19) pandemic has differentially affected HIV outcomes or drinking behavior among rural or ethnic minority populations. Understanding how COVID-19 changes HIV care and alcohol use could strengthen future HIV and alcohol care delivery to increase the resilience of these programs. Access to health research is also adversely affected by COVID-19. This shift to telehealth has potential to help clinicians and researchers connect with hard-to-reach populations. However, we need to understand feasibility and acceptability of telehealth by persons living with HIV (PLWH) if we are to extend research and improve delivery of alcohol interventions and HIV care in the future. This request is supplementary to U24AA022002, providing supportive infrastructure to the Southern HIV Alcohol Research Consortium (SHARC), including the FL Cohort. The objective of the FL Cohort is to better understand barriers and facilitators to viral suppression, focusing on alcohol use. However, the planned FL Cohort will not be able to distinguish if changes in alcohol use or HIV care are due to COVID-19, and will not have sufficient persons from rural or Haitian communities to assess differential effects in these underserved populations. This supplement will help determine how COVID-related social isolation and COVID disease have influenced the HIV care continuum, alcohol use and treatment, and acceptance of telehealth, stated interests in NOT-AA-20- 011 and high priority HIV research areas.
The aims of this supplement are to: 1) Determine the impacts of COVID disease and related changes in psychosocial factors (e.g., loneliness, social support, economic insecurity, domestic violence) on alcohol use and HIV-related care and health outcomes (ART adherence, care engagement, and viral suppression) as assessed before and during social distancing measures; 2) Extend FL Cohort recruitment into rural areas and the Haitian community, and compare the psychosocial effects, changes in drinking, and HIV-related outcomes in rural vs. urban settings and within the Haitian community. 3) Assess the feasibility, acceptability, and interest in remote enrollment and data collection for research, and delivery of alcohol interventions and HIV clinical care among patients and providers, and compare optimal strategies across socio-demographic groups (e.g., age cohort, rural vs. urban, ethnic groups). We will accomplish these aims by adding an additional COVID-related questionnaire to the existing measures in the parent FL Cohort study, recruiting and additional 150 persons from rural areas and the Haitian community who will complete a single, ?light? version of the study, and conducting qualitative interviews from PLWH and healthcare personnel to better understand how we can learn from the crisis to adapt new interventions. The study will have impact by directly informing strategies related to implementation of alcohol and HIV interventions, by expanding our knowledge related to the impact of a new infectious disease pandemic on drinking and HIV outcomes, and by enhancing the overall representativeness of our cohort sample.
This supplement will provide data on the impacts of the COVID-19 pandemic on HIV-related care and outcomes, alcohol use and misuse, and interest, feasibility, and acceptability of remote research activities and medical care (telehealth) at an opportune moment. It will also allow us to expand data collection into rural and underserved communities, who may be more vulnerable to the economic shocks from the pandemic. These additional aims align with those of the currently funded parent U24. This information can potentially inform future treatment programs for HIV and alcohol use among harder to reach members of the PLWH population.
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