R01AI170240

At the Intersection of HIV and COVID-19: Medicaid Data as a Complement to Cohort Studies - Abstract

The Coronavirus Disease 2019 (COVID-19) pandemic has had an unprecedented impact on the lives of people worldwide. Yet, the effect on persons living with HIV (PLWH) is not known. Emerging evidence suggests that PLWH have a similar or modestly higher risk of COVID-19 acquisition, and higher risk for worse COVID-19 outcomes, including hospitalization and death. However, the data has been mixed as several studies have suggested no difference in clinical outcomes.

Several studies also found that outcomes are worse among those without viral suppression and those with lower CD4 counts, highlighting the importance of continued HIV care. Yet, early reports suggest that COVID-19 has disrupted services across the HIV care continuum. As the pandemic continues to unfold, it is critical to better characterize the relationship between COVID and outcomes among PLWH. In addition, we need to identify how the pandemic and the public health strategies to combat the pandemic impacted the provision of care for PLWH, as well as whether any adverse effects are lasting.

Approximately 40% of PLWH are enrolled in Medicaid. The proposed project will include Medicaid beneficiaries from 27 states and Washington, DC between 2018 and 2024 with a conservative estimate of 25 million beneficiaries and 275,000 PLWH enrolled annually. Medicaid is an important complement to HIV cohort studies as it affords us the breadth of data to evaluate differences by geographic location, social determinants of health at the community level, as well as among important sub-populations.

We will assess the relationship between HIV and COVID-19 disease, including on hospitalization due to COVID-19 and adverse conditions due to COVID like post-acute sequelae of COVID-19 (PASC). We will also evaluate the impact of the COVID-19 pandemic on the provision of care for prevention of HIV and HIV care. We will assess care across the HIV care continuum including PrEP prescription, HIV testing, and annual HIV care visits, viral load tests, and ARV medication possession ratio. We will also evaluate impacts on the provision of care for non-HIV conditions, including annual wellness visits, preventive screenings, and health condition management.

We will compare care rates during the pre-COVID period (2001-2019), acute COVID period (2020-2021), and post-acute COVID period (2022-2024) overall and by geographic location (state, urban/rural, local government area [LGA], smallest government region e.g. county, city, town, etc.) and regional severity of COVID-19 cases and COVID-19 policies.

Findings from the proposed study will help inform and target interventions to improve care for PLWH in the future.

The Johns Hopkins University

TO ASSIST PUBLIC AND PRIVATE NONPROFIT INSTITUTIONS AND INDIVIDUALS TO ESTABLISH, EXPAND AND IMPROVE BIOMEDICAL RESEARCH AND RESEARCH TRAINING IN INFECTIOUS DISEASES AND RELATED AREAS, TO CONDUCT DEVELOPMENTAL RESEARCH, TO PRODUCE AND TEST RESEARCH MATERIALS. TO ASSIST PUBLIC, PRIVATE AND COMMERCIAL INSTITUTIONS TO CONDUCT DEVELOPMENTAL RESEARCH, TO PRODUCE AND TEST RESEARCH MATERIALS, TO PROVIDE RESEARCH SERVICES AS REQUIRED BY THE AGENCY FOR PROGRAMS IN INFECTIOUS DISEASES, AND CONTROLLING DISEASE CAUSED BY INFECTIOUS OR PARASITIC AGENTS, ALLERGIC AND IMMUNOLOGIC DISEASES AND RELATED AREAS. PROJECTS RANGE FROM STUDIES OF MICROBIAL PHYSIOLOGY AND ANTIGENIC STRUCTURE TO COLLABORATIVE TRIALS OF EXPERIMENTAL DRUGS AND VACCINES, MECHANISMS OF RESISTANCE TO ANTIBIOTICS AS WELL AS RESEARCH DEALING WITH EPIDEMIOLOGICAL OBSERVATIONS IN HOSPITALIZED PATIENTS OR COMMUNITY POPULATIONS AND PROGRESS IN ALLERGIC AND IMMUNOLOGIC DISEASES. BECAUSE OF THIS DUAL FOCUS, THE PROGRAM ENCOMPASSES BOTH BASIC RESEARCH AND CLINICAL RESEARCH. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM EXPANDS AND IMPROVES PRIVATE SECTOR PARTICIPATION IN BIOMEDICAL RESEARCH. THE SBIR PROGRAM INTENDS TO INCREASE AND FACILITATE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. THE SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM STIMULATES AND FOSTERS SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. RESEARCH CAREER DEVELOPMENT AWARDS SUPPORT THE DEVELOPMENT OF SCIENTISTS DURING THE FORMATIVE STAGES OF THEIR CAREERS. INDIVIDUAL NATIONAL RESEARCH SERVICE AWARDS (NRSAS) ARE MADE DIRECTLY TO APPROVE APPLICANTS FOR RESEARCH TRAINING IN SPECIFIED BIOMEDICAL SHORTAGE AREAS. IN ADDITION, INSTITUTIONAL NATIONAL RESEARCH SERVICE AWARDS ARE MADE TO ENABLE INSTITUTIONS TO SELECT AND MAKE AWARDS TO INDIVIDUALS TO RECEIVE TRAINING UNDER THE AEGIS OF THEIR INSTITUTIONAL PROGRAM.

93.855 - Allergy and Infectious Diseases Research

National Institute of Allergy and Infectious Diseases (NIAID) [HHS - NIH]

Baltimore, Maryland 212052103 United States

Single Zip Code

NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed) (PA-20-185)

Amendment Since initial award the End Date has been extended from 05/30/27 to 05/31/27 and the total obligations have increased 369% from $818,748 to $3,843,434.