SUMMARY/ABSTRACT
To determine correlates of poor vs. good HIV outcomes among people living with HIV (PLWH), researchers
have focused on clinical data. Hence, there is limited understanding of non-clinical correlates and migration
patterns of PLWH who have insecure (or fragmented) connections with the care system. This proposal will
leverage our unique access to clinical and non-clinical data to measure HIV care outcomes and identify
intervention opportunities to address insecure connection to care and poor outcomes inPLWH.
Our team has individually linked data from the Enhanced HIV/AIDS Reporting System (eHARS), the national
HIV surveillance database, with other public health, clinical, and criminal justice data. We use these data to
conduct population-level epidemiology of over 10,000 PLWH in Marion County (Indianapolis), Indiana
between 2000 and the present. We propose to link these data with social determinants of health data within
the Indiana Management Performance Hub (MPH), a collaborative state government data-sharing hub. MPH
data will complement our rich data repository by adding socioeconomic, household, and neighborhood
characteristics, social service utilization (welfare, food stamps, etc.), and mental health data for PLWH. Given
the complex intersection of social determinants of health and migration within and between counties (e.g.,
because of housing insecurity or discontinuity of insurance coverage), we will also investigate how migration
relates to insecure care connections and poor outcomes. Our access to these data sources will permit us to focus
on both social determinants of health and migration, and will provide us with the unprecedented ability
(1) to investigate how these factors relate to HIV outcomes over time, and (2) to identify intervention
opportunities (times and places) to improve connection to care and clinical outcomes in PLWH.
The objective of our research is to investigate correlates, and opportunities for improvement, of poor HIV
health outcomes in Marion County (Indianapolis), Indiana. The hypothesis is that identification of correlates
of poor retention in care and of poor viral suppression will identify opportunities to improve health outcomes
for PLWH who are insecurely connected to care. We aim to (1) Analyze patterns in social services utilization
among PLWH to (a) understand correlates of poor HIV outcomes and (b) identify non-clinical
opportunities for intervention; (2) Determine if within-county and between-county migration patterns
after diagnosis predict poor HIV care outcomes; (2a) Identify demographic, socioeconomic, life-course, and
contextual factors associated with worse HIV outcomes among those who migrate; and (3) Develop a model
to extend the utility of eHARS data for longitudinal research and public health practice, with guidance
from a stakeholder advisory panel. Results from this project will inform a subsequent R01 application
assessing whether supplemental wrap-around and outreach services for those identified at higher risk due to
non-clinical service utilization and migration patterns improve care and outcomes of PLWH.
