Social Determinants of Health and Quality of Cancer Care in HIV-associated Cancers

Northwestern University At Chicago, Evanston IL

Investigators

Linked publications, trials & patents

Abstract

Project Summary There are over 1.1 million people with HIV (PWH) in the United States, and nearly one-half (47%) are 50 or older. Even in the era of modern anti-retroviral therapy (ART) PWH are increasingly developing chronic co-morbid conditions associated with aging, including a variety of HIV-associated malignancies. The incidence of and mortality due to many HIV-associated cancers is exacerbated among PWH compared to HIV negative individuals. The etiology driving these findings is complicated but is thought to be due to lifestyle factors (e.g., smoking) and to pathophysiologic processes attributable to HIV. In addition to HIV-related inflammation, poor social determinants of health (SDoH) also contribute to higher levels of inflammation.13-15 SDoH include “the conditions in which people are born, grow, work, and live, and the wider set of forces and systems shaping the conditions of daily life.” SDoH have multiple domains (e.g., housing, primary care provider access, transportation, food security, medication affordability, substance use treatment, access to mental healthcare). In addition to these “conventional” domains, another key domain for socially minoritized populations is stigma as a fundamental SDoH. Indeed, systematic minoritization of socially stigmatized groups overarchingly shapes outcomes in other SDoH domains in these populations. These effects are often amplified among multiply minoritized populations. HIV disproportionately affects the health of many multiply minoritized groups, such as Black and Hispanic sexual minority men, transgender women of color, and Black cisgender women, among others. Studies indicate these multiply minoritized PWH populations are also often most likely to be impacted by HIV-associated cancers. These studies have largely focused on behavioral and/or clinical risk factors for malignancies without adequately addressing SDoH. Studies investigating how SDoH associate with disparities in the screening, diagnosis, treatment and outcomes of HIV-related malignancies among diverse – and especially multiply minoritized – PWH are therefore urgently needed. Our Chicago-based team thus proposes to accomplish the following Specific Aims: Specific Aim 1: Develop harmonized electronic medical record (EMR) algorithms to identify SDoH, demographic variables, and HIV care cascade outcomes as well as screening, diagnosis, and morbidity/mortality outcomes of HIV-associated malignancies of diverse PWH at UC and NM. Specific Aim 2: Investigate associations between SDoH and the screening, diagnosis, and morbidity/mortality outcomes of HIV-associated cancers and HIV care cascade outcomes among diverse PWH at UC and NM. The proposed project aligns with the highest impact NIH HIV/AIDS Research priorities. Its successful accomplishment will solidify collaborations in our interdisciplinary team to support a future R01 application in response to RFA-CA-22-056, “Basic/Translational Research on Health Disparities in Underrepresented People Living with HIV (PLWH) and Cancer.”