A Comprehensive Community-based Strategy to Optimize the HIV Prevention and Treatment Continuum for Youth At HIV Risk, Acutely Infected and with Established HIV Infection

一项以社区为基础的综合战略，旨在优化处于艾滋病毒风险、急性感染和已确诊艾滋病毒感染的青少年的艾滋病毒预防和治疗连续性

• 批准号: 9353195
• 负责人: Mary Jane Rotheram-Borus
• 金额: $ 373.86万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9353195
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Acute; Address; Adolescent; Adopted; Adult; Age; Americas; Behavior; Behavior Therapy; Behavioral; Bisexual; Blood; Caring; Centers for Disease Control and Prevention (U.S.); Chronic Disease; Clinical; Collaborations; Communication; Communities; Comorbidity; Consult; Data; Data Analyses; Data Collection; Development; Diffuse; Disease Progression; Disease remission; Drug usage; Economics; Epidemic; Evidence based intervention; Failure; Gays; HIV; HIV Infections; HIV Seronegativity; HIV risk; Health; High Prevalence; Homeless Youth; Homelessness; Human immunodeficiency virus test; Incidence; Infant; Infection; Intervention; Leadership; Life; Link; Literature; Los Angeles; Medical; Modeling; Monitor; Neighborhoods; Outcome; Perinatal; Prevention; Prophylactic treatment; Quality of life; Randomized; Randomized Controlled Trials; Recording of previous events; Recruitment Activity; Research; Research Personnel; Sampling; Scientist; Secure; Sexually Transmitted Diseases; Shelter facility; Site; Spottings; Structure; Subgroup; Technology; Testing; Time; Training; Treatment Efficacy; Triage; Universities; Viral; Viral Load result; Viral reservoir; Youth; adolescent health outcomes; aged; antiretroviral therapy; arm; base; brief intervention; care seeking; cohort; community center; comparison group; design; disorder prevention; evidence base; high risk; improved; novel; peer support; policy implication; pre-exposure prophylaxis; prevent; screening; skills; social media; standard care; success; therapy adherence; transgender; transmission process; trend; trial comparing; trial design

Project Summary/Abstract America's increasing HIV epidemic among youth aged 12-24 and our concurrent failure to identify, link to care, and achieve viral suppression among youth living with HIV (YLH) suggests the need to identify novel community-based strategies to leverage gateways and settings where high risk and infected youth can be engaged in HIV prevention and treatment. Scientific successes reducing HIV viral reservoirs among acutely infected infants, stopping HIV transmission from HIV-infected adults with undetectable viral loads, and documenting the efficacy of Treatment as Prevention (TASP) suggest strategies to reduce the trend of increasing adolescent HIV infections. This U19 will evaluate the usefulness of these advances for youth aged 12-24 at the highest risk of acquiring HIV- gay, bisexual, transgender youth (GBTY) and homeless youth (HY) – as well as youth living with HIV (YLH) in two HIV epicenters (Los Angeles and New Orleans). All GBTY and HY at five gay-identified community-based organizations (CBO) and homeless shelters will be screened over 18 months. From these screenings, a cohort of 220 YLH and 1,500 highest risk seronegative GBTY and HY will be formed. Over 24 months, this cohort will be repeatedly tested at four month intervals for sexually transmitted infections (STI) and serious drug use, and with 4th Gen HIV tests if seronegative, in order to identify acutely infected youth, engage youth in medical care, and monitor outcomes. Youth are triaged to: Study 1: Acute infection. Using 60 ARV-naive YLH with established infection as controls, we expect to identify 36 YLH with acute infection. All youth with acute infections will be aggressively treated with at least four highly potent antiretroviral therapies (ARV) and repeatedly assessed to examine if prolonged viral suppression is achieved, with reduced viral reservoirs to potentially allow ARV- free HIV remission. Study 2: Stepped care for YLH. Adapting strategies to manage chronic illnesses, we will conduct a RCT comparing a Standard Care Arm (repeated assessments every four month and an Automated Messaging and Monitoring Intervention [AMMI]) to Stepped Care. In the Stepped Care Arm, increasingly more intense interventions are delivered if viral load is detectable: a) the Standard Care Arm; b) an AMMI that is tailored to comorbidities of the specific YLH; or c) a Coach to support during crises, make treatment referrals, and brief interventions. Dried blood spots will monitor viral load and, on a small sample, ARV adherence over time. Study 3: Engaging seronegative youth in the HIV Prevention Continuum. Youth will be randomized to either: a) an AMMI Arm; b) Peer-Support plus AMMI Arm; c) eNavigator and an AMMI arm; or d) Peer-Support plus eNavigator plus AMMI Arm. Each condition aims to optimize the HIV Prevention Continuum. An interdisciplinary team of basic, clinical, and applied researchers with expertise in HIV, STI, behavioral interventions, biomedical interventions, CURE research, perinatal HIV, and a history of participating and coordinating multi-site RCT is participating on this U19 from six universities.

项目总结/文摘