This administrative supplement (PA-18-591) in response to NOT-AA-20-011, leverages an existing NIAAA U34 study for time-sensitive research on the impact of social environmental stressors related to COVID-19 on patient and provider experience in the HIV continuum of care for the most HIV-affected ethnic minority female populations in S. Florida, now in one of the epicenters of the new pandemic. The public health emergency posed by COVID-19 has caused unprecedented disruption in daily living, social structures, and employment as mitigation mandates of social distancing have been enforced to slow the spread of illness. Emerging evidence suggests that the most severe consequences from the novel coronavirus and the mitigation efforts will fall upon U.S. ethnic minority populations historically burdened by health disparities. The parent study, ?Optimizing PrEP Utilization among Alcohol and Other Drug (AOD) Using Women of Color? (U34AA026219), is the first such project devoted to improving implementation and uptake of PrEP among African American, LatinX and Haitian women in the HIV hotspots of S. Florida and has produced a replicable model driven by community-based participatory research (CBPR). Before COVID-19, these study populations had limited economic resources, prevalent health disparities and reported high levels of intimate partner violence. The possible deleterious effects of the pandemic have not yet been investigated or reported for women of color in the South or for the HIV health care providers that serve them. The supplement will utilize longitudinal, mixed methods data collection within the parent study?s social ecological framework to fill critical knowledge gaps about the pandemic?s impact on engagement in care and adherence to PrEP and supportive services for alcohol and drug use, mental health, and other ancillary care in the three key ethnic minority populations of women.
Our specific aims i nclude: 1) remotely assess experiences in AOD use, engagement in care, PrEP medication adherence, and HIV risk factors among a sample of women of color at risk for HIV who are currently enrolled participants in the parent study, comparing measures taken pre-COVID-19, (T1), to post-COVID assessments, (T2 and T3), taken 3 months apart; 2) measure via internet surveys changes in health services delivery and social distancing due to the pandemic on access to and perceived quality of care, patient trust, and provider stress among a group of health care workers who participated in the community mobilization phase of the parent study; and 3) remotely conduct semi-structured interviews with a subset of women from Aim 1 and health providers from Aim 2 to explore COVID-related experiences, needs, areas for improvement in care, and strategies to engage and retain AOD-using women in the HIV continuum of care. The methods and implementation of the proposed aims will be fulfilled within the parent study?s CBPR framework and will inform efforts to offset the adverse stressors of the pandemic and preserve gains that have been made in HIV prevention in these populations.
/Public Health Relevance Despite FDA approval in 2012, followed by recommendations from the CDC and WHO, the majority of women in the U.S. are not aware of oral pre-exposure prophylaxis (PrEP) as an HIV prevention strategy that applies to them. The proposed supplemental study will use a Community-Based Participatory Research (CBPR) model to to evaluate the impact of the COVID-19 pandemic on engagement in care and adherence to PrEP and supportive services for alcohol and drug use, mental health, and other ancillary care in women ethnic minority populations in S. Florida, the region with the highest HIV rates in the U.S. The counties targeted in the parent study are also the foremost hotspots for COVID-19 in the state but little is known about the pandemic?s effects on women who had been receiving or seeking HIV-related services prior to COVID-19 and the mitigation efforts. The methods and implementation of the proposed aims will inform efforts to offset the adverse stressors of the pandemic and preserve gains that have been made in HIV prevention in these populations
