PROJECT SUMMARY In the US, people with HIV (PWH) experience elevated mortality and morbidity due to cancer compared to the general population. Factors contributing to the disproportionate burden of poor cancer outcomes among PWH is likely multi-factorial, including inter-connected clinical and social factors. Among other factors, inequities in cancer treatment delivery to PWH is likely a contributor to low cancer-specific survival rates PWH face in the US. It is known that PWH are less likely to receive cancer treatment compared to their HIV-seronegative counterparts, even after factoring important clinical factors such as cancer type and cancer stage at diagnosis. Although significant prior research demonstrates PWH experience many social barriers to health care, a largely unexplored area is the role social determinants of health (SDoH) play in inequitable cancer treatment delivery to PWH. Insights into cancer treatment inequities among PWH in the context of multi-level SDoH, specifically individual-level factors such as insurance status and race/ethnicity as well as contextual SDoH based on an individual’s geographic social environment, will provide a critical opportunity to facilitate patient- and provider- level intervention development tailored to PWH. To address this gap in scientific knowledge, we propose to leverage a novel electronic health record (EHR)-based linkage of multiple health care systems across the state of Florida covering 19 million patients and 70% of adults living in Florida, called OneFlorida+. OneFlorida+ presents a novel, unprecedented context to characterize cancer treatment trends in the context of SDoH impacting PWH given Florida has among the highest rates of cancer in the US, a racially and ethnically diverse population, and one of the highest HIV incidence rates in the US. Our aims include: Aim 1: Enhance electronic health record data of patients with HIV and any invasive cancer with individual and contextual-level SDoH through developing novel NLP tools and linking external exposome databases; and Aim 2: Examine trends and social inequities in cancer treatment delivery to PWH diagnosed with invasive cancer. The present proposal will lead to three important outcomes: (1) the development of an interdisciplinary team of investigators dedicated to improving cancer care delivery and outcomes among PWH, a vulnerable priority cancer patient population in Florida 16; (2) establishment of the necessary research infrastructure to inform the development of paradigm shifting interventions; and (3) the discovery of novel insights into the interplay between SDoH, race/ethnicity, HIV, and cancer outcomes in FL’s context. Taken together, this one-year project provides a necessary foundation and the opportunity to apply an innovative lens to view important inequities in cancer control, and will provide timely, critical, policy relevant findings to facilitate interventions for delivery of equitable, high-quality cancer treatment t...