Grant Number:	1R01CA305812-01 Interpret this number
Primary Investigator:	Islam, Jessica
Organization:	H. Lee Moffitt Cancer Ctr & Res Inst
Project Title:	Harnessing Big Data to Understand the Confluence of HIV and Cancer Stigma in the Us Southeast
Fiscal Year:	2025

In the US, differences in cancer care quality impacting people with HIV (PWH) are stark, with up to one in four PWH not receiving any cancer treatment. Our preliminary evidence demonstrates HIV stigma is a major barrier to care among PWH with cancer, manifesting in healthcare settings in various ways including concerns regarding disclosure to caregivers and care refusal from healthcare providers. PWH with cancer also likely contend with cancer stigma, which is poorly understood within the context of living with comorbid HIV in the US. Little is known regarding mechanisms through which HIV and/or cancer stigmas impact care delivery to manage both HIV and cancer. Without such critical information, the promise of high-quality delivery of cancer care to PWH and management of HIV as a cancer survivor will likely remain unrealized in the US context. To address this gap in scientific knowledge, we propose a two-pronged approach where we will (1) leverage a novel electronic health record (EHR)-based linkage of multiple health care systems, covering over 24 million patients and 70% of adults living in Florida, called the OneFlorida+ Clinical Research Network (CRN), further linked with EHR data from Moffitt Cancer Center and prospective survey data collection using the CRN and at Moffitt; and (2) partner with community clinics serving PWH across FL to include and prioritize insights regarding the impacts of stigma on care delivery across the continuum starting from cancer treatment through survivorship managing both HIV and cancer. OneFlorida+ presents a novel, unprecedented context to characterize the impacts of stigma on care trends in PWH, given Florida has among the highest rates of cancer in the US, a heterogenous population, and one of the highest HIV incidence rates in the US. Our aims include: Aim 1: Estimate the direct and indirect relationships between individual- and contextual-level factors, HIV and cancer stigmas, and quality of cancer treatment and cancer survivorship care among people with HIV and cancer; Aim 2: Estimate the direct and indirect relationships between individual and contextual-level factors, HIV and cancer stigmas, and engagement in HIV survivorship care among people with HIV with cancer; and Aim 3: Examine patients’ experiences with stigma within healthcare systems as a PWH living with the dual burden of HIV and cancer through in-depth interviews. The successful completion of our proposed project will: (1) provide urgently needed evidence describing trends in treatment, and survivorship care among PWH with cancer to manage both conditions; (2) elucidate mechanisms through which stigma and multi-level factors contribute to the care inequities among PWH with cancer; (3) guide the development of multi-level intervention designs targeting stigma to be tested at Moffitt Cancer Center and CAN Community Heath care settings in future projects; and (4) create a large EHR-based cohort of PWH with cancer that can be longitudinally tracked to support future studies on care trajectories and associated health outcomes.





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