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However, risk from drought and floods is not evenly distributed spatially nor are all populations equally at risk for poor health outcomes. Globally, people living with HIV\/AIDS (PLHIV) face a particular set of challenges with EWE exposure including increased susceptibility to disease progression from care disruptions and medication adherence, and general population concentration in areas where rainfall is both highly variable and key to economic well\u2010being. To mitigate the impacts of EWE exposure on PLHIV, it is necessary to understand the historical EWE exposure patterns at HIV care clinics. In this paper, we link open\u2010source measures of drought and flood events to clinic locations from the International epidemiology Databases to Evaluate AIDS (IeDEA) network, a longitudinal study of over 2 million people living with and at risk for HIV in 44 different countries around the globe enrolling in HIV care from 2006 to present. Using generalized additive models fit to clinic\u2010level drought and flood exposures, we show how exposures vary across and within countries, model each clinic's probability of exposure to a drought or flood to identify high\u2010risk areas, and describe how this historical exposure record could ultimately be used to identify at\u2010risk populations for a wide variety of study designs. While EWEs occurred at HIV care clinics around the globe, we found that clinic locations in Southern Africa are particularly vulnerable to flood and drought events as compared to other IeDEA clinic regions and locations.<\/jats:p>","DOI":"10.1029\/2025gh001514","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T05:50:07Z","timestamp":1762235407000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Modeling the Burden of Extreme Weather Events in a Large Network of International HIV Care Cohorts"],"prefix":"10.1029","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0347-8881","authenticated-orcid":false,"given":"Sophia D.","family":"Arabadjis","sequence":"first","affiliation":[{"name":"Institute for Implementation Science in Population Health City University of New York Graduate School of Public Health and Health Policy  New York NY USA"},{"name":"University of California Center for Climate Health Equity University of California San Francisco  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Davenport","sequence":"additional","affiliation":[{"name":"Climate Hazards Center Department of Geography University of California  Santa Barbara CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"Vicedo Cabrera","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine University of Bern  Bern Switzerland"},{"name":"Oeschger Center for Climate Change Research University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Shahn","sequence":"additional","affiliation":[{"name":"Institute for Implementation Science in Population Health City University of New York Graduate School of Public Health and Health Policy  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Brazier","sequence":"additional","affiliation":[{"name":"Institute for Implementation Science in Population Health City University of New York Graduate School of Public Health and Health Policy  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Maroko","sequence":"additional","affiliation":[{"name":"Institute for Implementation Science in Population Health City University of New York Graduate School of Public Health and Health Policy  New York NY USA"},{"name":"Icahn School of Medicine at Mount Sinai Institute for Health Equity Research  New York City NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avantika","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Institute for Implementation Science in Population Health City University of New York Graduate School of Public Health and Health Policy  New York NY USA"},{"name":"Department of Epidemiology and Biostatistics City University of New York  New York City NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gad","family":"Murenzi","sequence":"additional","affiliation":[{"name":"Research for Development and Rwanda Military Referral and Teaching Hospital  Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3359-4947","authenticated-orcid":false,"given":"Timothy John","family":"Dizon","sequence":"additional","affiliation":[{"name":"Department of Health Research Institute for Tropical Medicine  Muntinlupa Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5068-6595","authenticated-orcid":false,"given":"Keri N.","family":"Althoff","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Jaquet","sequence":"additional","affiliation":[{"name":"Bordeaux Population Health Centre National Institute for Health and Medical Research (INSERM) UMR 1219 Research Institute for Sustainable Development (IRD) EMR 271 University of Bordeaux  Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aggrey S.","family":"Semeere","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute Makerere University  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanink","family":"Caro Vega","sequence":"additional","affiliation":[{"name":"Departamento de Infectolog\u00eda Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n  Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8039-6994","authenticated-orcid":false,"given":"Mark K. U.","family":"Pasayan","sequence":"additional","affiliation":[{"name":"Department of Health Research Institute for Tropical Medicine  Muntinlupa Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheri D.","family":"Weiser","sequence":"additional","affiliation":[{"name":"Division of HIV\/AIDS San Francisco General Hospital University of California at San Francisco  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Nash","sequence":"additional","affiliation":[{"name":"Institute for Implementation Science in Population Health City University of New York Graduate School of Public Health and Health Policy  New York NY USA"},{"name":"Department of Epidemiology and Biostatistics City University of New York  New York City NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"13","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2012.06.003"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0000429"},{"key":"e_1_2_9_4_1","unstructured":"Beguer\u00eda S. &Vicente\u2010Serrano S. 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