Multilevel Influences on HIV and Substance Use in a YMSM cohort

在这项竞争性更新中，我们建议继续对发生性行为的年轻男性进行最大规模的队列研究 与男性(YMSM)进行过的。这项雷达研究于2014年启动，旨在提供对风险的关键见解 以及艾滋病毒和毒品使用的保护因素，并找出促进因素和执行 结束疫情的有效战略。雷达反映了美国的艾滋病毒流行；它关注的是 艾滋病毒发病率最高的是少数族裔艾滋病毒差异群体(38%是黑人，30%是黑人 拉丁裔)，位于芝加哥，是艾滋病毒和毒品流行的城市中心(即库克县曾是 艾滋病毒发病率第四位--2017年)。在我们最初的资助期间，我们在招聘方面非常有成效 (N&gT；1,200)，留存(&gt；80%)，科学产出(40多篇论文)，培训未来学者，并担任 创新研究平台(25项以上互联研究；通过NIDA C3PNO联盟提出7个概念)。 在青少年和年轻人中，青年男性接触者占所有新诊断的艾滋病毒病例的近70% 在美国，虽然所有其他风险群体的发病率都在下降，但在 YMSM的颜色。在一个预防和治疗选择不断发展的时代，YMSM仍然表现出不充分的PrEP 艾滋病毒的使用率很高，从艾滋病毒护理的级联中下降。物质使用和少数人应激源，与 相关的社会、结构和生物过程是造成差异的关键因素。作为对.的回应 RFA-DA-20-005我们提出了一个复杂的多水平研究设计，在这个设计中，我们将在 2020年将有300名新的16-20岁儿童，并继续跟随现有的队列成员。在这次更新中，我们将 回答有关艾滋病毒和YMSM药物使用流行的关键新问题。首先(目标1)，我们将 保持对药物使用、艾滋病毒风险/预防行为和护理持续参与的新趋势的了解。 我们将绘制基督教青年会药物使用到成年期的发展轨迹，并将新的重点放在如何使用 轨迹和转变与毒品后果有关。此外，多个样本的登记 16-20岁(2008、2011、2015、2020)使我们能够理清历史(例如，PrEP的出现；大麻 在药物使用、艾滋病毒风险和护理方面的发展变化。下一步(目标2)，我们将继续 招募队列成员的新的认真合作伙伴。我们将通过纵向检查密钥来扩展我们之前的工作 二元过程在物质使用问题和艾滋病毒危险行为的发展中所起的作用 耦合的YMSM之间的传输。第三(目标3)，我们将基于我们对高水平的 通过收集致病生物标记物在雷达队列中的系统性炎症，而与HIV状态无关 物质使用开始预测HIV+和HIV-YMSM的晚年发病率。最后(目标4)，雷达将 继续将样本和数据添加到我们特征良好的生物行为库中，为 高影响力的科学。雷达是对不同YMSM的独特的多层次和纵向研究-它的延续 将提供关键数据，为结束艾滋病毒流行的战略提供信息。

In this competing renewal, we propose to continue the largest cohort study of young men who have sex with men (YMSM) ever conducted. The RADAR study was launched in 2014 to provide critical insights into risk and protective factors for HIV and drug use, and to identify facilitators and barriers to the implementation of an effective strategy to end the epidemic. RADAR is reflective of the US HIV epidemic; it focuses on the ages with the highest HIV incidence, has exceptional representation of minority HIV disparity groups (38% black, 30% Latino), and is located in Chicago, an urban epicenter of the HIV and drug epidemics (i.e., Cook County was 4th in HIV incidence-2017). During our initial grant period, we were extremely productive in recruitment (N>1,200), retention (>80%), scientific outputs (40+ publications), training future scholars, and serving as a platform for innovative research (25+ connected studies; 7 concepts via NIDA C3PNO consortium). YMSM account for nearly 70% of all new HIV diagnoses among adolescents and young adults each year in the U.S. While all other risk groups have declining incidence, dramatic increases continue among YMSM of color. In an era of evolving prevention and treatment options, YMSM still show insufficient PrEP utilization and fall off the HIV care cascade at high rates. Substance use and minority stressors, with associated social, structural, and biological processes, are key factors that drive disparities. In response to RFA-DA-20-005 we propose a sophisticated multilevel research design, in which we will enhance the cohort in 2020 with 300 new 16-20 year olds and continue to follow existing cohort members. In this renewal, we will answer critical new questions about the HIV and substance use epidemics in YMSM. First (Aim 1), we will keep a pulse on emerging trends in drug use, HIV risk/preventive behaviors, and care continuum engagement. We will chart YMSM developmental trajectories of drug use into adulthood, with a novel focus on how use trajectories and transitions are associated with drug consequences. Further, enrollment of multiple samples of 16-20 year olds (2008, 2011, 2015, 2020) allows us to disentangle historical (e.g., advent of PrEP; marijuana legalization) and developmental changes in substance use, HIV risk and care. Next (Aim 2), we will continue to enroll cohort members’ new serious partners. We will extend our prior work by longitudinally examining the key role that dyadic processes play in the development of substance use problems and HIV risk behaviors and transmission among coupled YMSM. Third (Aim 3), we will build on our provocative findings of high levels of systemic inflammation in the RADAR cohort regardless of HIV status by collecting pathogenic biomarkers of substance use to begin forecasting later-life morbidities for HIV+ and HIV- YMSM. Finally (Aim 4), RADAR will continue to add specimens and data to our well-characterized biobehavioral repository to provide a platform for high-impact science. RADAR is a unique multilevel and longitudinal study of diverse YMSM—its continuation will provide critical data to inform strategies to end the HIV epidemic.