Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, The University of South Carolina, Columbia, SC, USA.
South Carolina SmartState Center of Health Quality, Columbia, USA.
AIDS Behav. 2024 Oct;28(Suppl 1):61-76. doi: 10.1007/s10461-023-04138-5. Epub 2023 Aug 1.
The global COVID-19 pandemic has imposed unprecedented pressure on health systems and has interrupted public health efforts for other major health conditions, including HIV. It is critical to comprehensively understand how the pandemic has affected the delivery and utilization of HIV-related services and what are the effective strategies that may mitigate the negative impacts of COVID-19 and resultant interruptions. The current study thus aims to comprehensively investigate HIV service interruptions during the pandemic following a socioecological model, to assess their impacts on various outcomes of the HIV prevention and treatment cascade and to identify resilience resources for buffering impacts of interruptions on HIV treatment cascade outcomes. We will assess HIV service interruptions in South Carolina (SC) since 2020 using operational report data from Ryan White HIV clinics and HIV service utilization data (including telehealth use) based on statewide electronic health records (EHR) and cellphone-based place visitation data. We will further explore how HIV service interruptions affect HIV prevention and treatment cascade outcomes at appropriate geospatial units based on the integration of multi-type, multi-source datasets (e.g., EHR, geospatial data). Finally, we will identify institutional-, community-, and structural-level factors (e.g., resilience resources) that may mitigate the adverse impacts of HIV service interruptions based on the triangulation of quantitative (i.e., EHR data, geospatial data, online survey data) and qualitative (i.e., in-depth interviews with clinic leaders, healthcare providers, people living with HIV, and HIV clinic operational reports) data regarding health system infrastructure, social capital, and organizational preparedness. Our proposed research can lead to a better understanding of complicated HIV service interruptions in SC and resilience factors that can mitigate the negative effects of such interruptions on various HIV treatment cascade outcomes. The multilevel resilience resources identified through data triangulation will assist SC health departments and communities in developing strategic plans in response to this evolving pandemic and other future public health emergencies (e.g., monkeypox, disasters caused by climate change). The research findings can also inform public health policymaking and the practices of other Deep South states with similar sociocultural contexts in developing resilient healthcare systems and communities and advancing epidemic preparedness.
全球 COVID-19 大流行给卫生系统带来了前所未有的压力，并中断了针对包括艾滋病毒在内的其他主要健康问题的公共卫生工作。全面了解大流行如何影响艾滋病毒相关服务的提供和利用，以及哪些有效策略可能减轻 COVID-19 的负面影响和由此产生的中断，这一点至关重要。因此，本研究旨在根据社会生态学模型全面调查大流行期间艾滋病毒服务中断情况，评估其对艾滋病毒预防和治疗各个环节结果的影响，并确定缓冲中断对艾滋病毒治疗环节结果影响的弹性资源。我们将利用南卡罗来纳州（SC）的 Ryan White HIV 诊所的运营报告数据以及基于全州电子健康记录（EHR）和基于手机的位置访问数据的 HIV 服务利用数据（包括远程医疗使用情况），评估自 2020 年以来 SC 的艾滋病毒服务中断情况。我们将进一步探索如何根据多类型、多源数据集（例如 EHR、地理空间数据）的整合，在适当的地理空间单位上评估艾滋病毒服务中断对艾滋病毒预防和治疗各个环节结果的影响。最后，我们将根据有关卫生系统基础设施、社会资本和组织准备情况的定量（即 EHR 数据、地理空间数据、在线调查数据）和定性（即对诊所领导、医疗保健提供者、艾滋病毒感染者和 HIV 诊所运营报告的深入访谈）数据，确定机构、社区和结构层面的因素（例如弹性资源），这些因素可能会减轻艾滋病毒服务中断的不利影响。我们提出的研究可以更好地了解 SC 复杂的艾滋病毒服务中断情况，以及可以减轻这些中断对各种艾滋病毒治疗各个环节结果负面影响的弹性因素。通过数据三角化确定的多层次弹性资源将有助于 SC 卫生部门和社区制定战略计划，以应对这一不断演变的大流行和其他未来的公共卫生紧急情况（例如，猴痘、气候变化引起的灾害）。研究结果还可以为公共卫生政策制定和具有类似社会文化背景的其他美国南部各州提供信息，以建立有弹性的医疗保健系统和社区，并推进疫情应对准备工作。
