Influence of patient-centered HIV care on retention and viral suppression disparities

Abstract: Antiretroviral therapy leads to viral suppression which not only prevents the progression of humanimmunodeficiency virus (HIV) infection to acquired immunodeficiency syndrome and death among people livingwith HIV (PLH), but also prevents the transmission of HIV. Therefore, viral suppression is one of the keyindicators 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, includingimmunosuppression, to stay home. These and other necessary steps to combat COVID-19 had a far-reachingimpact on HIV care; most HIV medical case management sites and HIV clinicians began delivering care viatelehealth or telephone, reducing the availability of in-person services. Furthermore, the ripple effects due tothe loss of the tourist industry and closure of nonessential businesses have led to widespread unemploymentand economic hardship within the community with 67,000 unemployment claims as of April 21st. The RyanWhite Program (RWP) serves about 52% of PLH in the United States and is the provider of last resort, servinguninsured 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 caredelivery and are experiencing significant hardships such as food insecurity. The objective of this study is tocharacterize the COVID-19 PHE-related changes in HIV care delivery (e.g. use of telehealth and other remotemodes of delivery) and any related difficulties and the COVID-19 PHE-related socioeconomic and psychosocialhardships experienced by RWP clients and assess how these have affected HIV viral suppression amongRWP clients. A further objective is to compare the effects by racial/ethnic and gender groups to identify anypotential inequities. To accomplish these objectives, we will interview 300 RWP clients by telephone (130Hispanic, 100 African American, and 70 Haitians with roughly half men and half women in each group) abouttheir HIV care and COVID-19 PHE-related socioeconomic and psychosocial stressors and compare their HIVviral loads before and after the onset of the COVID-19 PHE. This study will provide important information abouthow the COVID-19 PHE is impacting viral suppression among RWP clients, and the extent to which COVID-19PHE-related stressors are novel barriers to care. Any inequitable impacts by race/ethnicity and gender will alsobe examined. This information is also critical, because due to the immune suppression experienced by manyPLH, it is likely that social distancing measures may be needed during HIV care delivery for an extendedperiod of time during the current pandemic.