Alcohol Research Consortium in HIV: Epidemiology Research Arm

Unhealthy alcohol use is prevalent among people with HIV (PWH) and associated with poor outcomes including less engagement in the HIV Care Continuum (HIV-CC) and increased age-related comorbidities. Alcohol Research Consortium in HIV-Epidemiology Research Arm (ARCH-ERA) was formed to investigate short and long-term effects of alcohol on outcomes among PWH in the CFAR Network of Integrated Clinical Systems (CNICS). CNICS is an 8-site network that is a large, geographically and racially diverse, gender representative cohort of >37,000 PWH in care. Careful outcomes adjudication, a large diverse population, and systematic longitudinal assessments of patient reported alcohol use, drug use, mental health symptoms, adherence, and context-based factors such as housing status, stigma, and social support enables a rigorous approach to key questions on HIV and alcohol that are highly responsive to NIH HIV priorities and RFA-AA-20- 009. Our rapid response to the COVID-19 pandemic demonstrates the remarkable agility of CNICS to adapt to changes in health care and research priorities as they emerge. We have previously described the high prevalence of unhealthy alcohol use among PWH, and its detrimental effects on outcomes including HIV-CC steps. We build on that work focusing on the HIV-CC in the current era of a pandemic and expanding telehealth; expanding focus to including the Alcohol Care Continuum (Alc-CC) as well as additional patterns of alcohol use; adding age-related outcomes such as heart failure that are becoming increasingly important in the aging population of PWH; and incorporating emerging outcomes such as due to COVID-19-related illness. Capitalizing on the resources and infrastructure of CNICS, we propose the following aims: 1. Obtain, expand, improve, and validate high quality alcohol and social determinants of health data including expanding CNICS PROs to better capture alcohol use patterns and adding U.S. Census data to better capture socioeconomic context; 2. Examine longitudinal relationships of alcohol use, drug use, and mental health disorders on the HIV-CC and Alc-CC including impacts of the pandemic and key social determinants of health such as among sometimes hidden or marginalized groups of PWH. 3. Determine clinical outcomes among PWH with unhealthy alcohol use including age-related comorbidities and COVID-19 related illness, and the role of alcohol use patterns and social determinants of health on these and other long-term outcomes. ARCH-ERA will capitalize on and expand CNICS's comprehensive clinical data to address novel research questions on the impact of alcohol use among PWH including generating new knowledge on the intersection of HIV and alcohol to inform future research and clinical care. ARCH-ERA will enhance the overall ARCH consortium by providing new and expanded data types, informing alcohol interventions, and leveraging results from this rich cohort to provide data and address important questions focusing on the impact of alcohol use patterns on current care and health outcomes of PWH within the modern pandemic context.