RCMI@Morgan: Center for Urban Health Disparities Research and Innovation (2)

PROJECT Summary: Similar to HIV and hepatitis C virus, SARS-CoV-2, the cause of COVID-19, is most devastating to people ofhealth disparity populations (HDP). However, we hypothesize that COVID-19 could cause health disparitiesamong different HDP (i.e. "disparities within") and certain circumstances and determinants could contribute toand predict the "disparities within". Our ongoing partnerships with a multi-hospital healthcare system and amultisite community health center for the study of HIV/HCV-related health disparities provide an immediate,practical, and pertinent platform to study the impacts of COVID-19 on health outcomes and healthcare accessand utilization among people of various HDP. The hospitals of the healthcare system and the clinics of thecommunity health center are situated in urban, suburban, and rural areas with major health disparities. Thehealthcare system has provided SARS-CoV-2 testing services and treated many hospitalized COVID-19patients. The community health center provides HIV care to people of racial/ethnic and sexual/gender minoritiesand other vulnerable populations. We will take advantage of the ongoing partnerships, using a retrospectivecohort study design with data from the medical records, to dissect the "disparities within" caused by COVID-19.First, we will delineate the clinical features and natural history of COVID-19 among the hospitalized patients, anddetermine the factors associated with COVID-19 pathogenesis, disease severity, and treatment effectiveness.We also aim to establish novel, unique, and tailored clinical "scoring" systems/models that can be used to predictCOVID-19 outcomes and severity in patients of different HDP. Second, we will analyze the trends in andcharacteristics of the SARS-CoV-2 testing and assess whether people of the HDP were underrepresented in thetesting. We will also analyze the factors associated with SARS-CoV-2 positivity among those tested. For thosewho tested positive, we will assess their participation/engagement in the COVID-19 cascade of care anddetermine the factors associated with attending or missing each of the stages in the care cascade. Next, we willassess the HIV continuum of care during the COVID-19 lockdown, analyzing the trends and factors associatedwith missing appointments, labs, and/or prescriptions as well as the utilization of telehealth. We will also examinethe HIV-related health outcomes among those who continued care during the lockdown. Finally, we will performquestionnaire surveys or interviews to assess the experiences and perceptions of (1) COVID-19 patient carefrom the frontline healthcare workforce and (2) the pros and cons of telehealth in HIV care from the HIV patientsand care providers. We will also evaluate how the COVID-19 pandemic has changed/shaped the perception andcareer/specialty choice of the medical residents, interns, and students. The results from this project will helpreduce the health disparities caused by COVID-19 among the HDP.PROJECT SUMMARY