Keeping it LITE 2: Exploring HIV Risk in Vulnerable Youth with Limited Interaction and Digital Health Intervention (LITE-2)

摘要 尽管在艾滋病毒诊断、护理和预防战略方面取得了进展，但青少年和年轻人的感染率仍然很低， 性和性别少数群体（SGM）在美国继续上升。迫切需要描述 流行病学和艾滋病毒感染的轨迹在这一人群中，并提供年龄和文化上适当的可扩展的 在美国，对感染风险最高的人进行预防干预。该项目将吸引和留住年轻的SGM， 一个创新的纵向队列，将他们纳入一个动态的数字健康保留平台（HMP）; HealthMPowerment），监测艾滋病毒风险和预防行为，并探索影响艾滋病毒感染的社会生态因素。 使用新的艾滋病毒预防技术（UG 3阶段），同时还允许对新的数字健康进行有针对性的测试 第三阶段（UH 3）。我们还将测试扩展HMP核心版本（HMP Basic）的效果， 坚持工具（HMP增强）为那些谁是准备或艺术，以提高依从性和持久性。在目标1中， 我们将招募并保留一个大的（n=6000; 3000/年）性活跃的SGM青少年和年轻人的多样化队列 13-34岁的成年人，使用创新的数字招聘，参与和保留策略。在研究过程中， 我们将纵向描述SGM的性行为、HIV传播风险和PrEP摄取轨迹 青年利用流行病学轨迹分析确定最有效的干预点（目标2）。为宗旨 3，我们将开展一项随机临床试验，以检查HMP增强对改善PrEP依从性的有效性 HIV阴性青年（n ≥750）和HIV阳性青年（n ≥150）的ART依从性，与HMP Basic相比。 最后，我们将通过测试新的和创新的数字健康设备，艾滋病毒/性传播感染， 诊断和干预措施，由以前的目标以及新兴的NIH预防优先事项（目标4）通知。我们 调查小组在招募、预防和照顾SGM青年和大规模SGM方面拥有数十年的经验。 纵向队列研究。这项研究将利用现有的富有成效的合作伙伴关系和数字健康专业知识， 阐明美国最脆弱人群中持续的艾滋病毒流行的驱动因素，以确定 最有效、迅速和可扩展的战略，以应对这一持续的公共卫生危机。

ABSTRACT Despite advances in HIV diagnostics, care and prevention strategies, infection rates among adolescent and young adult sexual and gender minorities (SGM) continue to rise in the United States (US). There is an urgent need to describe the epidemiology and trajectories of HIV acquisition in this population and to offer age and culturally appropriate scalable prevention interventions to those at highest risk of infection in the US. This project will engage and retain young SGM in an innovative longitudinal cohort, enroll them in a dynamic established digital health retention platform (HMP; HealthMPowerment), monitor HIV risk and prevention behaviors and explore the socioecological factors that influence the use of new HIV prevention technologies (UG3 phase), while also allowing targeted testing of novel digital health interventions (UH3 phase). We will also test the efficacy of expanding the core version of HMP (HMP Basic) by adding adherence tools (HMP Enhanced) for those who are on PrEP or ART to improve adherence and persistence. In Aim 1, we will enroll and retain a large (n=6000; 3000/year), diverse cohort of sexually active, SGM adolescents and young adults, ages 13-34, using innovative digital recruitment, engagement and retention strategies. Over the course of the study, we will longitudinally characterize the sexual behavior, HIV transmission risk, and PrEP uptake trajectories of SGM youth utilizing epidemiological trajectory analyses to identify the most effective points of intervention (Aim 2). For Aim 3, we will launch a randomized clinical trial to examine the efficacy of HMP Enhanced to improve PrEP adherence among HIV-negative youth (n ≥750) and ART adherence among HIV-positive youth (n ≥150) compared to HMP Basic. Finally, we will maximize the productivity of the cohort by testing new and innovative digital health devices, HIV/STI diagnostics and interventions, informed by the previous aims as well as emerging NIH prevention priorities (Aim 4). Our investigative team has decades of experience with recruitment, prevention and care of SGM youth and large-scale longitudinal cohort studies. This study will capitalize upon productive existing partnerships and digital health expertise to articulate the drivers of the ongoing HIV epidemic among the most vulnerable populations in the US in order to identify the most effective, expeditious and scalable strategies to address this ongoing public health crisis.