Examining Health Disparities in the use of Hematopoietic Cell Transplants for HIV-related Lymphoma - Project Summary/Abstract People living with HIV (PLWH) are at increased risk of developing HIV-related lymphoma, are less likely to receive cancer treatments such as chemotherapy and radiotherapy, and the likelihood of receiving a curative treatment such as hematopoietic cell transplant (HCT) for HIV-related lymphoma is unknown. There are no definitive guidelines for HCT use in HIV-related lymphoma, despite studies demonstrating equivalent overall survival between those with and without HIV. Current evidence is limited by small samples or single-center studies conducted with highly specialized infectious disease teams. Clinical challenges unique to HIV include added risks for infections and hospitalizations, and drug-drug interactions between antiretrovirals and chemotherapy, contributing to the lack of HCT adoption in HIV-related lymphoma. Inequities in HCT utilization in HIV-related lymphoma are influenced by social determinants of health. Patients who are Black/African American, do not have private insurance, and have low socioeconomic status are less likely to receive HCT in general, but these barriers to HCT in HIV-related lymphoma have never been studied. This proposal will characterize the social determinants of health that influence HCT utilization in patients with HIV-related lymphoma, and elucidate if supportive measures are needed to address differences in care outcomes based on HIV status. Our central hypothesis is that in HIV-related lymphoma patients, certain social determinants of health are associated with less HCT utilization, and that PLWH have distinct treatment burden and hospital use. We will test our hypothesis via the following Specific Aims: 1) Measure the associations between sociodemographic and clinical factors on HCT utilization in patients with HIV-related lymphoma, and 2) Test for differences in treatment burden, hospital use, and survival outcomes between lymphoma HCT recipients with and without HIV. Our research team at UC Davis linked an innovative dataset using the Center for International Blood and Marrow Transplant Research (CIBMTR), California Cancer Registry, and California Patient Discharge Data that will be used in cohort and matched case-control designs in this F31 proposal. By completing the training objectives in this F31, the applicant will gain the skills necessary to become an independent nurse scientist and Principal Investigator, while characterizing inequities in HCT utilization and disparities in care outcomes influenced by social determinants of health. Specifically, through a mentoring team spanning UC Davis, UC San Francisco, and Stanford University the F31 applicant will 1) Acquire skills in epidemiologic approaches (population health), secondary analysis, and advanced biostatistics, 2) Gain HIV clinical management expertise, 3) Advance knowledge in health equity, health disparities, and social determinants of health, and 4) Leadership and professional development to become a principal investigator.
