Longitudinal assessment of the impact of COVID-19 on social determinants of health among African Americans with HIV

Background 

The aim of this study was to examine the impact of COVID-19 on social determinants of health among African Americans with HIV. The impact of COVID-19 has been devastating for all individuals; however, it poses an increased risk for individuals with chronic health conditions type 2 diabetes, obesity, and HIV. Research has shown, among individuals with comorbidities, African Americans have a higher prevalence and poorer prognosis of COVID-19, with death rates being two to three times higher than their white counterparts.

Non-medical factors are key drivers of health outcomes and inequities. Patient reported health outcomes expounded by social determinants of health depicts how vulnerable populations are faring over a year into the pandemic. 

Methods

A longitudinal survey employing face-to-face interview questions at three time points was used to address the study objective. Participants were part of a larger ongoing study to examine the impact of medication therapy management (MTM) visits on patients' health. The inclusion criteria for the larger study were adults ≥18 years, the presence of hypertension or diabetes, and a positive HIV diagnosis being managed by anti-retroviral therapy. Participants selected for the presented study met the original inclusion criteria and had study visits within the time points defined as pre-COVID, during COVID, and post-COVID. Participants were excluded if they did not have study visits within all three time points or did not meet any of the initial inclusion criteria upon screening. Ten questions that examined social determinants of health and overall well-being were extracted from a larger survey instrument used at each study visit. Participants met with pharmacists approximately every three months per the study protocol. Descriptive statistics and inferential statistics were used to analyze survey responses. A proportional odds mixed effects logistic regression model was used to assess differences between time points. 

Results

A total of 27 participants were included. The average age of participants was 53. The sample was similarly distributed by gender (52% females, 48% males). Almost half of the participants had hypertension alone (48%) and the remainder (52%) had both hypertension and diabetes. Participants' responses to the survey questions were fairly consistent across all three time points. The mean response to the questions increased (more favorable) from time point 1 to time point 2. Additionally, the means were higher between time point 2 and 3. There was a significant difference between time point 3 and time 1 (odds ratio [OR] = 16.39, 95% CI [1.08-37.73], p= 0.04), regarding the statement "In the last month, I felt like my safety was threatened because of the place I sleep or live." A greater proportion of participants reported a score of 5 on this question indicating they strongly disagreed with the statement.

Conclusions

The results showed a statistically significant difference in participants feeling safer where they reside or slept post-COVID compared to pre-COVID. This perhaps can be explained by the rent and mortgage moratoriums, and housing protections provided by the Coronavirus Aid, Relief, and Economic Security (CARES) Act.