Following a U.S. National Cohort of Vulnerable Men to Improve HIV Prevention and Care

项目摘要 RFA-AI-16-031(LITE)旨在通过使用创新的 技术来登记和跟踪感染风险最高者的大规模流行病学队列。这个 拟议的项目将利用已建立的基于互联网的策略，该研究曾成功使用过这些策略 团队，招募5000名艾滋病毒阴性的高危男同性恋者、双性恋者和其他与男性发生性行为的男性 (GBM)16至49岁--每年新感染人数比例最高的人群--以及 前瞻性地跟踪他们四年。我们的建议的设计特点是专门为：(A) 确定艾滋病毒血清转换的个人、网络和背景层面的预测因素和相关因素，(B)确定 在研究过程中，那些血清转换者错过了艾滋病毒预防机会，因此，(C) 告知干预措施，以进一步减少获取和传播。 我们将“高风险”定义为符合CDC的PrEP治疗指南，但不服用PrEP。参与者将 完成年度自行管理的家庭快速艾滋病毒检测(通过检测的数字照片提交结果 划桨)以及简短(~20分钟)的家庭电脑调查。除了被转介接受治疗外， 血清转换的研究参与者将完成半结构化电话采访，以识别遗漏的艾滋病毒 预防机会和所涉及的背景因素。我们将监测新诊断的参与者的 在艾滋病毒护理连续体中的行动。根据目前的发病率，我们预计 研究期间约有252例感染；然而，由于我们针对的是高危男性，这个数字可能是 再高一点。 目标1(UG3阶段)：建立5,000名未接受PrEP的高危HIV阴性GBM队列，所有 谁完成基线在线调查和家庭自我管理的艾滋病毒检测，以及同意 纵向随访。在研究登记12个月后确定PrEP摄取率和HIV发病率。 补充目的：使用在筛选研究期间被认为不合格的GBM的横断面数据 资格：SUP。目标1a-估计PrEP和Sup的摄取。目标1b-确定遗漏的艾滋病毒的特征 最近艾滋病毒血清转换者的预防机会(例如，以前没有使用PrEP的原因)。 目标2(UH3阶段)：跟踪队列四年，以确定(2a)个人/网络/背景层面的特征 PrEP摄取/停用的决定因素；(2b)新的艾滋病毒血清转换和错过的艾滋病毒预防 机会，包括个人/网络/背景层面的决定因素；(2c)#年的种族/族裔差距 艾滋病毒发病率及其随时间的趋势；以及(2)PrEP对种族/民族差异的影响。

Project Summary RFA-AI-16-031 (LITE) is designed to address critical needs in HIV prevention research by using innovative technology to enroll and follow large-scale epidemiological cohorts of those at highest risk of infection. The proposed project will utilize established Internet-based strategies, previously used successfully by the research team, to enroll a sample of 5,000 high-risk HIV-negative gay, bisexual, and other men who have sex with men (GBM) ages 16 to 49—the population representing the highest percentage of new infections annually—and follow them prospectively for four years. The design features of our proposal were chosen specifically to: (a) identify individual-, network-, and contextual-level predictors and correlates of HIV seroconversion, (b) identify missed HIV prevention opportunities among those seroconverting during the course of the study, and, thus (c) inform interventions to further reduce acquisition and transmission. We define “high-risk” as meeting CDC guidelines for PrEP treatment, but not taking PrEP. Participants will complete annual self-administered at-home rapid HIV testing (results submitted via digital photo of the test paddle) as well as brief (~20 min) at-home computerized surveys. In addition to being referred for treatment, study participants who seroconvert will complete a semi-structured telephone interview to identify missed HIV prevention opportunities and the contextual factors involved. We will monitor newly diagnosed participants' movement through the HIV care continuum. Based on current incidence rates, we anticipate accumulating ~252 infections during the study; however, because we are targeting high-risk men, this number could be higher. Aim 1 (UG3 Phase): Establish a cohort of 5,000 high-risk HIV-negative GBM who are not on PrEP, all of whom complete baseline online surveys and at-home self-administered HIV testing, as well as consent for longitudinal follow-up. Determine PrEP uptake and HIV incidence 12 months after study enrollment. Supplemental Aims: Using the cross sectional data from GBM deemed ineligible during screening for study eligibility: Sup. Aim 1a—Estimate the uptake of PrEP; and Sup. Aim 1b—Characterize missed HIV prevention opportunities (e.g., reasons for no prior PrEP use) among recent HIV seroconverters. Aim 2 (UH3 Phase): Follow the cohort for four years to characterize (2a) individual/network/contextual-level determinants of PrEP uptake/discontinuation; (2b) new HIV seroconversions and missed HIV prevention opportunities, including individual/network/contextual-level determinants; (2c) racial/ethnic disparities in HIV incidence and their trends over time; and (2d) the influence of PrEP uptake on racial/ethnic disparities.