The COVID-19 global pandemic and allostatic load among a cohort of Black and Latina transgender women living with HIV.

This exploratory study investigated the impact of the COVID-19 pandemic on stress biomarkers and allostatic load for Black and Latina transgender women living with HIV (BLTWLH), as well as COVID-19 infection, hospitalization, and vaccination status. LITE Plus is a longitudinal cohort study of BLTWLH designed to identify pathways linking biopsychosocial stress to HIV co-morbidities. Participants were enrolled between October 2019-June 2022. Descriptive statistics compared stress biomarkers and allostatic load index (ALI) scores pre- (to March 2020) and post-onset pandemic onset (January 2021-December 2022). Frequencies and proportions are reported for COVID-19 indicators. Of the cohort, 26 BLTWLH completed study visits both pre- and post-onset pandemic onset ("pre-onset"; "post-onset"). Post-onset, chronic stress biomarkers were elevated across all body systems. Sample ALI distribution shifted post-onset, with elevated mean, median, IQR and proportion above the median. Of the 108 participants who completed any post-onset visits, 19% had ever tested positive for COVID-19 and 4% reported a COVID-19 related hospitalization. COVID-19 vaccination uptake was 70% and 24% had received a booster. Of those unvaccinated, 15% intended to be vaccinated, 9% were unsure and 6% did not intend to be vaccinated. BLTWH deployed various strategies to cope with pandemic effects and 22% reported unmet COVID-19-related support needs. ALI for BLTWLH was high compared to other populations in the literature, suggesting unique vulnerabilities to biopsychosocial stress and chronic disease risk. Despite high engagement with COVID-19 prevention including vaccination intention and uptake, BLTWLH experienced heavy COVID-19 burden and unmet support needs.