Investigating and Addressing Modifiable Factors in the HIV Care Continuum for People with HIV (PWH) affected by Substance Use and Mental Health

About This Grant

Project Summary Investigating and Addressing Modifiable Factors in the HIV Care Continuum for People with HIV (PWH) affected by Substance Use and Mental Health Social determinants of health like poverty, and unstable housing, combine synergistically with comorbidities like substance use (SU) + mental health (MH) as a syndemic to disproportionately burden disadvantaged populations people living with HIV (PWH). Substance use and mental health comorbidities are associated HIV Continuum of Care Outcomes (HCC) like delayed entry into care, lower retention in care, reduced ART adherence, poor VL suppression, and higher mortality for PWH. For the US to end the HIV epidemic (EHE) by 2030, the underlying mechanisms of SRD- driven health disparities on viral suppression and HCC outcomes among all PWH experiencing substance use and mental health syndemic must be elucidated and addressed. The lack of suitable comprehensive longitudinal data to examine substance use, and mental health impact on dynamic changes in HCC outcomes limits our ability to end the HIV epidemic. Defining and describing the impact of substance use and mental health on HCC outcomes requires examining the complex interactions of sociocultural, economic, environmental, and geographic contexts influencing these interactions. To address the knowledge gaps on modifiable factors related to the intersection between SU+MH, we propose using real-world multiple linked datasets, including enhanced HIV/AIDS surveillance (e-HARS), Electronic Health Records (EHR), Department of Mental Health data, Department of Alcohol and Other Drugs of Abuse (DAODAS) data, corrections data administrative claims, and other relevant public data sources, to investigate the disparities in SU, MH recognition, treatments, and HCC outcomes using data science. We will use qualitative methods to examine interpersonal and intra-individual factors to identify modifiable factors for moderating the effects of the intersection of SU+MH on viral suppression and the HCC. The specific aims are to: 1. Examine and visualize the longitudinal patterns/trends, heterogeneity, and disparities arising from SU on viral suppression and other HCC outcomes among PWH in SC; 2. Determine the interactive effect of SU+MH on viral suppression and other HCC outcomes; and 3. Understand experiences and impact of SU+MH on viral suppression and other HCC outcomes among PWH population in SC using focus group discussions/in-depth interviews.