key: cord-0823697-x428w7yz authors: Algarin, Angel B.; Varas-Rodríguez, Emil; Valdivia, Chelsea; Fennie, Kristopher P.; Larkey, Linda; Hu, Nan; Ibañez, Gladys E. title: Symptoms, Stress, and HIV-Related Care Among Older People Living with HIV During the COVID-19 Pandemic, Miami, Florida date: 2020-04-17 journal: AIDS Behav DOI: 10.1007/s10461-020-02869-3 sha: fdd2897a9087b4c5f30584a948f18c261d6a58b8 doc_id: 823697 cord_uid: x428w7yz nan discussed the possibility of using Zoom videoconferencing to continue the intervention; however, after much discussion with investigators and staff, it was decided that this was not a viable option for our participants for the following reasons: limited data plan on smartphones, lack of computer in the home, lack of privacy to do the intervention, and lack of knowledge regarding videoconferencing. In addition, based on conversations with our program officer, it was also determined that videoconferencing the intervention would change the nature of the intervention itself. Although the clinical trial was temporarily suspended, we continued to contact our participants weekly via phone calls as per study protocol; however, we also used it as a 'check-in' and added a few questions, with IRB approval, regarding the coronavirus situation to track any possible adverse events. As part of the weekly calls during the COVID-19 social distancing period, participants are currently being asked a subset of 7 questions related to their potential symptoms of COVID-19, experiences in SARS-CoV-2 testing, the effects on their HIV care, and stress during the COVID-19 pandemic. This Note describes some of the preliminary information gathered from the first of these weekly ongoing calls. Of the 24 participants in the first cohort of the clinical trial, five participants were lost to follow up, and there were another 3 currently enrolled participants that were not able to be reached by phone during the first call. Sixteen of the 19 currently enrolled participants completed the COVID-19 related factors questionnaire. Demographic information can be found in Table 1 . We asked our participants about their potential COVID-19 symptoms based off of the CDC recommendations used to screen people into testing [5] . Among the sample, 3 participants experienced one potential symptom of COVID-19 which were a productive cough (n = 2) and a dry cough (n = 1). However, the participants who listed productive cough as a symptom said that the cough preceded the COVID-19 pandemic. Four participants sought SARS-CoV-2 testing, but interestingly none of the participants who reported symptoms were those who sought testing. Three of those who sought testing received a test. Two tested negative and 1 participant was awaiting results. The participant who was unable to receive testing indicated that it was due to being unaware that an appointment was necessary to receive a test. These findings could highlight potential barriers in educating older PLWH in COVID-19 symptoms and testing; particularly as it pertains to (1) identifying symptoms of COVID-19, (2) knowing who should be tested for SARS-CoV-2, (3) the appropriate protocol to procure a test depending on location (i.e. drive through testing vs appointment driven testing). When looking at the effects of COVID-19 on HIV care, we found among participants who had HIV care appointments since the initiation of social distancing (n = 12), ten participants were able to keep their HIV health care appointments. Among those who made their appointments, two mentioned their visit transitioning to 'telehealth'. All participants were able to receive their HIV antiretrovirals (n = 16). Among those who were aware they had a case manager (n = 12), two were not able to keep in contact with their case manager, but mentioned difficulty even before social distancing. We were also interested in the stress that participants were feeling during this period of COVID-19 and social distancing. We asked participants to rank their stress since social distancing from 1 to 10 with higher scores indicative of greater stress. The average level of stress reported by our sample due to COVID-19 was 4.4 ± 3.3 with scores ranging from 1 to 10. Among the most stressful things participants reported were potential exposures to SARS-CoV-2, adjusting to social distancing, and issues related to finances. One participant reported a perceived benefit, noting that the connection to an emergent social support system had decreased their perceived loneliness. Preliminary findings from our weekly calls to older people living with HIV suggest that most of our participants continue to receive HIV care in person, although telehealth was reported by some and could be an important alternative to in-person care in the future. One participant did report not being able to get a SARS-CoV-2 test because they did not have an appointment. It is unclear why this was the case. Clinics should prioritize certain vulnerable populations such as older PLWH for testing, or perhaps provide testing during a routine care visit if available. Stress levels do seem to be impacted by COVID-19, and for our participants, stress revolved around its impact on their health, on their sense of social isolation, and their economic situation. For example, one participant asked if they could receive the study incentive even if the trial was suspended. Researchers should consider how suspension of studies may financially affect their target population. We did not ask about social isolation directly; however, anecdotally, our research interviewer has observed how happy our participants are to receive his phone calls and to talk to someone. One participant was so grateful, he states, she cried during the phone call. Social isolation and mental health should be assessed and addressed during such a crisis event. Several policy implications should be considered. Previous guidelines have been composed to address the deleterious effects of natural disasters on HIV care. However, these Moving forward, we will continue to conduct weekly calls to our participants; and once the trial begins again, this first cohort will complete the intervention. However, their preand post-data has been impacted by COVID-19. To address this, and if approved, we will add another cohort of participants. In sum, weekly phone calls can help researchers maintain contact with participants and provides an option for further data collection. We also believe that our weekly phone calls to all our participants are helping them stay connected and puts us in a position to help them in the case an emergency arises. Novel Coronavirus Outbreak (COVID-19) Naming the coronavirus disease (COVID-19) and the virus that causes it An interactive web-based dashboard to track COVID-19 in real time peopl e-at-highe r-risk. html?CDC_AA_refVa l=https %3A%2F%2Fwww .cdc.gov%2Fcor onavi rus%2F201 9-ncov%2Fspe cific -group s%2Fhig h-risk-compl icati ons Centers for Disease Control and Prevention. Symptoms of Corona Virus. 2020 Acknowledgements This work was supported by the National Center for Complementary and Integrative Health (NCCIH) Grant R34AT009966.