PROJECT SUMMARY With the advent and widespread use of highly active antiretroviral therapy, people living with HIV (PLWH) are living longer and are aging into demographics at higher risk of developing cancers not traditionally linked with HIV or AIDS known as, non-AIDS defining cancers. PLWH are more likely to experience non-AIDS defining cancer-specific mortality compared to their HIV-negative counterparts. Unequal delivery of cancer care across the continuum may contribute to the disproportionate burden of both morbidity and mortality associated with cancer among PLWH. Cancer survivorship care is an integral part of high-quality cancer care and should begin at cancer diagnosis throughout the cancer care continuum to address several aspects of the cancer treatment experience including side effects, financial hardship, mental and physical health, health promotion, and continued surveillance of cancer progression or secondary cancer. Equitable receipt of cancer survivorship care can improve long-term outcomes such as survival and quality of life, however, little is known regarding delivery of survivorship care to PLWH in the U.S Research to inform the optimal model of survivorship care delivery for HIV-positive cancer survivors is particularly urgent due to the complexity that may arise from multi-level factors impacting PLWH in the U.S. including the unique social issues and biological sequalae of living with HIV as a chronic disease, however, currently limited research exists. To fill this gap in scientific knowledge, we will leverage longitudinal data collected from the MACS/WIHS Combined Cohort Study (MWCCS), the longest US longitudinal study of PLWH (Aims 1 & 2), as well as data collected prospectively from HIV-positive cancer patients treated at one NCI-designated cancer center in a high burden HIV state (Aim 3) to carry out the following specific aims: (1) Aim 1: Estimate differences and identify determinants (clinical, behavioral, and social) of cancer survival among non-AIDS defining cancer survivors living with and without HIV; (2) Aim 2: Evaluate longitudinal changes in individual-level clinical (e.g., general comorbidities, adherence to ART), physical (e.g., frailty, activities of daily living), and psychosocial (e.g., depression, quality of life) outcomes after a non-AIDS defining cancer diagnosis and whether these changes differ by HIV status; and (3) Aim 3: Explore the role of patient cancer care quality on cancer survivorship outcomes among people living with and without HIV with a non-AIDS defining cancer diagnosis. Taken together, successful completion of these aims will lead to the identification of intervenable opportunities to improve cancer survivorship outcomes among PLWH. This preliminary work will inform future large-scale projects to design and implement cancer survivorship care plans to ultimately improve cancer survivorship outcomes (specifically survival and quality of life) and reduce the inequitable burden of cancer ...