PROJECT SUMMARY Similar to HIV and hepatitis C virus, SARS-CoV-2, the cause of COVID-19, is most devastating to people of health disparity populations (HDP). However, we hypothesize that COVID-19 could cause health disparities among different HDP (i.e. “disparities within”) and certain circumstances and determinants could contribute to and predict the “disparities within”. Our ongoing partnerships with a multi-hospital healthcare system and a multisite community health center for the study of HIV/HCV-related health disparities provide an immediate, practical, and pertinent platform to study the impacts of COVID-19 on health outcomes and healthcare access and utilization among people of various HDP. The hospitals of the healthcare system and the clinics of the community health center are situated in urban, suburban, and rural areas with major health disparities. The healthcare system has provided SARS-CoV-2 testing services and treated many hospitalized COVID-19 patients. The community health center provides HIV care to people of racial/ethnic and sexual/gender minorities and other vulnerable populations. We will take advantage of the ongoing partnerships, using a retrospective cohort study design with data from the medical records, to dissect the “disparities within” caused by COVID-19. First, we will delineate the clinical features and natural history of COVID-19 among the hospitalized patients, and determine the factors associated with COVID-19 pathogenesis, disease severity, and treatment effectiveness. We also aim to establish novel, unique, and tailored clinical “scoring” systems/models that can be used to predict COVID-19 outcomes and severity in patients of different HDP. Second, we will analyze the trends in and characteristics of the SARS-CoV-2 testing and assess whether people of the HDP were underrepresented in the testing. We will also analyze the factors associated with SARS-CoV-2 positivity among those tested. For those who tested positive, we will assess their participation/engagement in the COVID-19 cascade of care and determine the factors associated with attending or missing each of the stages in the care cascade. Next, we will assess the HIV continuum of care during the COVID-19 lockdown, analyzing the trends and factors associated with missing appointments, labs, and/or prescriptions as well as the utilization of telehealth. We will also examine the HIV-related health outcomes among those who continued care during the lockdown. Finally, we will perform questionnaire surveys or interviews to assess the experiences and perceptions of (1) COVID-19 patient care from the frontline healthcare workforce and (2) the pros and cons of telehealth in HIV care from the HIV patients and care providers. We will also evaluate how the COVID-19 pandemic has changed/shaped the perception and career/specialty choice of the medical residents, interns, and students. The results from this project will help reduce the health disparities caused by COVID-19 among the HDP. PROJECT SUMMARY

PROJECT NARRATIVE COVID-19 is most devastating to people of health disparity populations (HDP) and may also cause health disparities among different HDP (disparities within). This project will assess the clinical features and treatment outcomes among hospitalized COVID-19 patients of various HDP, the trends and characteristics associated with SARS-CoV-2 testing, positivity, and subsequent cascade of care among people of various HDP, as well as the experiences and perceptions from the frontline healthcare providers. In addition, we will determine the impact of COVID-19 lockdown on HIV continuum of care and HIV-related health outcomes among people living with HIV. PROJECT NARRATIVE