URBAN ARCH (5/5) Boston Cohort - Alcohol and HIV-associated comorbidity and complications: Frailty, Functional impairment, Falls, and Fractures (the 4F study)

This proposal is an urgent competitive revision designed to supplement an existing NIH-funded study to assessthe impact of the COVID-19 pandemic on alcohol and other drug use, and medication adherence that is criticalfor preventing HIV disease progression, among people living with HIV (PLWH). The COVID-19 pandemic hasprofoundly affected lives around the world. In addition to the effects of infection itself, to which PLWH may bemore susceptible, COVID-19 has affected employment, access to healthcare, and very likely, the incidenceand consequences of other health conditions, by limiting access to healthcare, and through the implementationof physical (social) distancing. PLWH may be at higher risk of consequences of social isolation, and those withaddiction, unemployment and homelessness are at an even higher risk with restrictions that affect foodavailability, hygiene (e.g. handwashing), shelter, and other traditional supports now absent from the alreadyfragile societal safety net. The over-arching goal of this proposal is to assess the impact of the COVID-19 pandemic and the effects ofphysical (social) distancing and other mitigation strategies (collectively termed "pandemic exposure") onsubstance use (heavy alcohol use and/or other drug use including nonmedical prescription medication use)and HIV medication adherence among PLWH. Among an ongoing, well-characterized cohort of people living with HIV/AIDS (the existing Boston ARCHCohort parent study), this project will:Aim 1: Determine prospective associations between pandemic exposure and changes in alcohol (and otherdrug) use (primarily) and HIV antiretroviral (ARV) medication nonadherence (secondarily).Aim 2: Identify associations between pandemic exposure and secondary stressors, specifically, foodinsecurity, loneliness, and pain interference (with activities); and associations between those stressors andchanges in alcohol (and other drug) use and HIV ARV medication nonadherence.Aim 3: Determine who is most affected by the pandemic by examining moderators of the associations betweenpandemic exposure and changes in substance use and HIV ARV nonadherence. To achieve these aims, a supplemental COVID-19 specific assessment will be administered to participantsat two time points (6 months apart). Baseline data on substance use, depression, and frailty, collected duringpre-pandemic assessments as part of the parent study will be compared against data collected viasupplemental COVID-specific assessments. Achieving this proposal's aims is an important step to identifyingmodifiable targets for interventions to prevent increased substance use and HIV disease progression after anextreme event such as COVID-19.