Effects of overlapping Pandemics on Coping and behavioral Health among young adults affected by HIV (EPOCH-HIV)

The COVID-19 pandemic has dramatically disrupted everyday life for many young people, including young adults who have grown up with perinatally-acquired HIV (YAPHIV). YAPHIV were vulnerable to poor health outcomes (mental illness, substance use, low rates of viral suppression) before the pandemic due to the multifaceted impact of HIV, racism, and poverty. YA who were perinatally HIV-exposed, but uninfected (YAPHEU) have grown up in similar vulnerable communities, but often without the same access to services as YAPHIV. In this R21, we will examine the Effects of the COVID-19 Pandemic On Coping and behavioral Health among young adults affected by HIV (EPOCH-HIV) in order to inform care and interventions that address behavioral health problems and HIV treatment and prevention for Black and Latinx YA affected by HIV. Leveraging resources from a longitudinal cohort of YAPHIV and YAPHEU (CASAH; R01-MH69133), and our collaboration with the Northeast/Caribbean AIDS Education and Training Center (NECA AETC), we will inform the tailoring of behavioral and physical health services to meet the needs of YA affected by HIV in an era of overlapping HIV and COVID-19 pandemics. CASAH has collected extensive psychosocial, psychiatric, and behavioral data on YAPHIV and YAPHEU, and health outcomes (including HIV outcomes) from 2003 (n=340; mean age 12 years) to the present (mean age 27 years). To achieve EPOCH-HIV's aims, we will use latent class analysis (LCA) (Aim 1) to identify pandemic experience typologies (i.e., highly affected, moderately affected, minimally affected) based on pandemic-related changes to psychosocial factors (e.g., job/housing loss, trauma). We will then explore risk and protective factors for these typologies (e.g., race/ethnicity, gender, PHIV status, social support) as well as the relationship between pandemic experience typologies and the following outcomes: (a) behavioral health (i.e., mental health, substance use), (b) vaccine and booster uptake, c) physical health (e.g., body mass index, health care visits), and (d) YAPHIV viral suppression. Sampling from participants in each of these typologies, we will qualitatively examine lived experiences before and during the COVID-19 pandemic (Aim 2), to identify areas for modification in (a) behavioral health (b) vaccine and booster uptake, and (c) physical health, and (d) YAPHIV care. Our multidisciplinary team has expertise in infectious diseases, COVID-19, mental health, YA, perinatal HIV, qualitative methods, mHealth, structural racism, trauma, and psychosocial and behavioral intervention development, and together are uniquely positioned to conduct this work. Public Health Impact: EPOCH will use rigorous and innovative methods to identify and begin to address how the COVID-19 pandemic affected the behavioral and physical health and care for of YA affected by HIV. Our partnership with NECA AETC and leaders in health services will enable us to reach providers and rapidly disseminate findings and inform the tailoring of services to address the NIH OAR priorities of: 1) reducing health disparities in HIV incidence and treatment outcomes, 2) addressing HIV co-morbidities, 3) making a substantive research-to-practice clinical impact.