Human Immunodeficiency Virus (HIV) was diagnosed in 30,635 people in the U.S. in 2020, with about half
of people with HIV (PWH) retained in care. HIV health outcomes are impacted by the circumstances in
which a person lives and the wider set of social forces that shape a person’s life known as social determinants
of health (SDH). Providers can supplement missing or coarsely defined SDH data from structured electronic
health record (EHR) sources with clinical notes. Indigenous, specifically American Indian and Alaska Native
(AN/AN), PWH have unique histories and sociopolitical conditions that contributes to SDH factors not captured
by generic SDH categories. However, culturally congruent Indigenous SDH (ISDH) are not well
understood in terms of 1) categorical definitions, 2) discussion in clinical notes, and 3) their predictive power
for HIV outcome modeling. In this K99/R00 application, we propose building community collaborations and
leveraging EHR data to elucidate how ISDH are defined and can be deployed within the clinical setting. In the
K99 phase, we will collaboratively define ISDH with AI/AN PWH through qualitative interviews. In the R00
phase, we will use natural language processing to extract ISDH from clinical notes and measure their
predictive power for modeling health outcomes such as retention in care and future risk of HIV. Our specific
aims are: (1) describe ISDH through collaborations with AI/AN PWH (n=20) and health organizations; (2)
identify ISDH in clinical notes AI/AN patients (n=30,097); and (3) measure the predictive power of ISDH with
HIV health outcomes for AI/AN PWH (n=199) and AI/AN patients at risk for HIV (n=359). The training
objectives of this project include developing competencies in qualitative methods and data analysis,
community-based participatory research approaches, and building strong, reciprocal relationships with
Indigenous communities and health organizations. The long-term training goal is to support Dr. Bear Don’t
Walk to transition to faculty and build an independent research program. Dr. Bear Don’t Walk seeks to lead an
interdisciplinary team of quantitative and qualitative health researchers, clinicians, and Elders, committed to
developing analytic methods to better understand indicators, behavioral, and lifestyle characteristics, and
other causes of health disparities, with a focus on community engagement. To ensure success for the
planned research and training, a multidisciplinary mentorship team with a breadth of expertise, stellar
mentorship records, and established, well-funded research programs will advise Dr. Bear Don’t Walk.
Additionally, the research and training will be conducted at a world-renowned university and academic medical
center with exceptional community engagement resources, and biomedical informatics research expertise.
The proposed research is both significant and innovative because it elucidates ISDH from three complimentary
views on how ISDH are: 1) conceptualized and defined by Indigenous PWH, 2) understood and discussed by
clinicians in the clinical note, and 3) associated with important health outcomes for PWH in the EHR.
