Keeping it LITE: Exploring HIV Risk in Vulnerable Youth with Limited Interaction

项目摘要/摘要 作为对RFA-AI-16-031的回应，我们建议“保持轻量级：探索弱势青少年感染艾滋病毒的风险 有限互动“，它将使用电子招聘来吸引年轻的MSM和TGW参与创新的 旨在监测艾滋病毒风险和预防行为的队列，并探索 以最小的投入影响行为和态度。这种低交互策略将使我们能够 描述整个芝加哥地区持续的感染趋势，并描述个人和社区层面的特征 增加艾滋病毒风险的因素，同时将参与研究和研究的潜在干预效果降至最低 它本身。此外，鉴于艾滋病毒预防技术的快速发展，我们将使用我们的大型、 对未感染艾滋病毒的青年进行纵向队列调查，以监测随时间推移PrEP的获取、吸收和依从性。更多 深入研究那些在队列中登记时感染艾滋病毒的人，以及在 基线，使用创新的社交网络和系统动力学分析，将确定持续活跃的集群 将新的靶向生物医学预防方法的可行性传播并测试到最高级别的人 风险亚组。随着纵向数据的积累，我们将做好设计和试运行虚拟 针对年轻男男性接触者和TGW的最佳艾滋病毒预防策略。我们建议的方法可确保 最大可能在艾滋病毒预防方面取得有意义的进展，包括开发工具 以及易于实施和可扩展的战略，以出口到其他患有类似疾病的社区 艾滋病毒感染的流行。我们提出以下具体目标：目标1：招收和保留一大批人 13-34岁MSM和TGW(每年1000人，超过3年)感染艾滋病毒的高危人群使用经过测试的新技术 以及通过社交媒体和有针对性的电子广告实施具有成本效益的招生战略。目标1a： 捕获在研究过程中发生的至少230例HIV血清转换，以及之前的300例 未确诊的感染艾滋病毒的青年。目标1b：探索行为、场所、社会人口学特征和 预测HIV感染的社会生态影响。目标2(UH3阶段)：描述真实世界的PrEP 在纵向队列中登记和保留的年轻MSM和TGW中使用，并探索个体， 提供者和社区层面预测PrEP摄取率、PrEP依从性和PrEP停用情况。目标3 (UH3阶段)：使用社会网络和系统动力学分析来确定正在进行的 在队列中登记的年轻MSM和TGW中艾滋病毒血清转换者的传播网络。目标3a： 为增强型合作伙伴服务和新型生物医学预防的优化设计和目标确定提供数据 战略。目标4(UH3阶段)：描述新诊断的年轻MSM/TGW的艾滋病毒护理连续过程 目标4a：确定最终病毒抑制的个人、网络、社区和结构预测因素。

PROJECT SUMMARY/ABSTRACT In response to RFA-AI-16-031, we propose “Keeping it LITE: Exploring HIV Risk in Vulnerable Youth with Limited Interaction,” which will use electronic recruitment to engage young MSM and TGW in an innovative cohort designed to monitor HIV risk and prevention behaviors and explore the socioecological factors that influence behavior and attitudes with minimal engagement. This low-interaction strategy will allow us to describe ongoing infection trends across the Chicago area and characterize individual and community level factors that enhance HIV risk, while minimizing the potential intervention effects of study participation in and of itself. Further, given the rapidly advancing state of HIV prevention technologies, we will use our large, longitudinal cohort of HIV-uninfected youth to monitor PrEP access, uptake and adherence across time. More intensive study of those who acquire HIV while enrolled in the cohort, as well as those “prevalent positives” at baseline, using innovative social network and phylodynamic analysis, will identify clusters of ongoing active transmission and test the feasibility of novel approaches to target biomedical prevention to those in the highest risk subgroups. As the longitudinal data accumulate, we will be well-poised to design and pilot test virtual strategies for optimal HIV prevention for young MSM and TGW. Our proposed methodologies assure the maximum likelihood of leading to meaningful advances in HIV prevention including the development of tools and strategies that are easily implemented and scalable for export to other communities suffering from similar epidemics of HIV infection. We propose the following specific aims: Aim 1: To enroll and retain a large cohort of 13-34 year-old MSM and TGW (1000/year over 3 year) at high risk of HIV acquisition using tested, novel and cost-effective enrollment strategies through social media and targeted electronic advertisement. Aim 1a: To capture at least 230 HIV seroconversions occurring over the course of the study and 300 previously undiagnosed HIV-infected youth. Aim 1b: To explore behaviors, venues, sociodemographic characteristics and socioecological influences that predict HIV acquisition. Aim 2 (UH3 Stage): To characterize real-world PrEP use among young MSM and TGW enrolled and retained in a longitudinal cohort and explore the individual, provider and community-level predictors of PrEP uptake, PrEP adherence and PrEP discontinuation. Aim 3 (UH3 Stage): To use social network and phylodynamic analysis to identify characteristics of ongoing transmission networks of HIV seroconverters among young MSM and TGW enrolled in the cohort. Aim 3a: To provide data for optimal design and targeting of enhanced partner services and novel biomedical prevention strategies. Aim 4 (UH3 Stage): To describe the HIV care continuum among newly diagnosed young MSM/TGW Aim 4a: Identify individual, network, community and structural predictors of eventual viral suppression.