Title : Addressing COVID-19 disparities through an HIV framework
The prolific spread of COVID-19 in the U.S. has overburdened our clinical healthcare system and magnified significant gaps in the delivery of care. In a matter of months, stark disparities in COVID-19 morbidity and mortality rates emerged in communities of color, evoking a pattern of poor outcomes parallel to that of HIV in minority populations. Evidence suggests that the disparities in COVID-19 outcomes are heavily rooted in socioeconomic inequities, many of which overlap as drivers of HIV disparities among Black communities across the Nation.
Miami Dade County, in particular, experiences some of the greatest racial disparities in HIV outcomes. While Blacks comprise just 17% of County residents, they accounted for nearly half of people living with HIV in 2018 and 64% of AIDS-related deaths, indicating critical gaps in the HIV care continuum among this population. Similarly, Black Miami residents accounted for 21% of COVID-19 related deaths as of April 2020, resulting in a mortality rate of 6.1% compared to 3.9% among Whites.
One promising strategy to overcome such social and economic barriers to care has been the use of Community Health Workers (CHWs). Identified by the Department of Homeland Security “essential infrastructure workers” during the response to the COVID-19 emergency,” CHWs play a critical role in both public health and safety as well as community well-being. Respected and well-known by their neighbors and local residents, CHWs have a deep understanding of the health and social needs of the community that make them effective at improving local health outcomes.
Over the last decade, our CHW-led interventions have established a robust network of community partners to improve access to HIV testing and linkage care among Black adults in Miami’s high-risk regions. CHW interventions have a similar potential to support COVID-19 screening and vaccination efforts by promoting awareness, dispelling myths, and ensuring access to highly vulnerable communities. Few health systems, however, have explored this approach in response to the pandemic.
Leveraging our existing CHW network, we have adapted our CHW-led HIV screening strategies to increase COVID-19 vaccination efforts among Miami’s high risk minority communities. To ensure our approach is aligned with community values and norms, we have partnered with nine community-based organizations to identify acceptable approaches to incorporate COVID-19 education and vaccination into our existing CHW protocols. From July through September 2021, CHWs provided 20,064 local residents with education on the COVID-19 virus, its risk factors, and the safety of the vaccines; 1,276 individuals were screened for COVID-19, and 2,713 people received the vaccine. These preliminary findings support the use of CHW-led interventions as effective and adaptable strategies to improve access to care and reduce disparities is a variety of health outcomes.