Yale University

Understanding the impact of COVID-19 on individuals with HIV with tobacco use: A mixed-methods Study

Principle Investigator(s):

Funder: National Institute of Mental Health
Project period: 06/08/2020 - 06/07/2021
Grant Type: Research

Abstract Text:

Coronavirus disease 2019 (COVID-19) has created an unprecedented global health emergency. Due to COVID-19 itself and the associated public health guidance for social distancing, multi-level factors may interact to uniquely threaten the health of people with HIV (PWH). Immunosuppression, lung disease and other comorbidities, particularly cardiovascular disease, have been identified as risk factors for COVID-19 and are associated with HIV. Factors known to impact achievement of HIV viral suppression, including substance use and mental illness, may be exacerbated by stress associated with social distancing and COVID-19 related fears. Similarly, PWH may experience loss of employment with disruptions in access to food and housing due to the COVID-19 context. This may all occur in the broader context where PWH are experiencing disruptions in routine HIV care with transitions to telehealth. As tobacco use increases risk of comorbidities, often co-occurs with other substance use and mental illness, and is a more common among individuals of lower socioeconomic status, PWH who smoke are likely to be particularly vulnerable in the COVID-19 context. Furthermore, given differences in their types of social networks and interactions with technology as an information source and for telehealth, older and younger PWH are likely to differ in their experiences in the COVID-19 context.

To generate time sensitive insights on how PWH are responding to COVID-19 and its impact on their health and health behaviors, we propose a two-site convergent parallel mixed-methods study to be based at the Yale-New Haven Hospital HIV clinics in New Haven, CT and SUNY Brooklyn STAR Program, in Brooklyn, NY. These clinics are located in the United States northeast, where COVID-19 cases and mortality has been substantial. We will conduct 2-4 focus groups by videoconference with a convenience sample of clinicians and staff employed at each of these clinics to gain their insights on factors impacting their patients and patient responses to COVID-19. In a parallel process, we will conduct a telephone-based survey of younger and older PWH with tobacco use engaged in care (n=300) to assess the impact of individual and clinical social distancing on HIV care (HIV viral load, CD4 count, retention in care) and telehealth experiences among older and younger PWH (Aim 1); and to characterize COVID-19 awareness, behaviors, and experiences (Aim 2).The proposed study will be conducted by a team with relevant expertise and collaborative history. In addition, we will have potential to compare experiences of PWH to those of other adults with chronic medical conditions. We will ground our approach in the Promoting Action on Research Implementation in Health Services Research (PARiHS) and RE-AIM implementation science frameworks to gain timely data on how the current context is impacting delivery of HIV care and how public health guidance regarding COVID-19 is reaching PWH and its effectiveness. This study is highly consistent with CIRA's priorities with its goal of reducing health disparities among PWH with social and medical vulnerabilities.