Pathways to Successful Aging Among Perinatally HIV-infected and Exposed Young Adults: Risk, Resilience, and the Role of Perinatal HIV Infection

在过去的18年里，CASAH跟踪了340名主要是黑人和拉丁美洲人/一名患有围产期获得性疾病的青年。 艾滋病毒（PHIV）和围产期暴露于艾滋病毒但感染了艾滋病毒的青年（PHEU）-年龄在9-16岁， 纽约市的社区-记录儿童、青少年和 成年初显期现在，在其第四个竞争延续（R 01 MH 69133 -19）中，CASAH 4，正如它所知， 在这个队列中，青年期（YA; 20 - 30岁出头）。CASAH做出了重大贡献， 研究艾滋病毒感染者和PHEU青年的健康风险和复原力以及这些结果的社会决定因素 发表了超过125篇出版物和80篇科学报告，并直接为心理健康和艾滋病毒提供了信息， 预防干预和服务系统在美国和国外。CASAH以社会行动理论为指导 (SAT)，CASAH 4专门研究：1）HIV感染对行为健康结果的影响（例如， 心理健康、性风险、物质使用、依从性）和成人里程碑的实现（例如，教育、 职业，独立性）; 2）SAT知情的风险和保护因素如何影响YA行为健康， 成年里程碑的实现; 3）青春期和青年期的行为健康轨迹， 这些轨迹的SAT信息预测因子;以及4）行为健康结果及其SAT信息 全球青年群体（如美国、泰国、南非）的预测因素。CASAH 4增加了生物医学 健康指标（与精神和神经认知相关的炎症和免疫激活生物标志物） 功能）与已收集的HIV RNA病毒载量和CD 4+细胞计数数据进行比较。通过其正在进行的历史性工作， CASAH拥有关于心理健康，酒精/物质使用， 行为健康，以及患有PHIV的青少年和年轻人的里程碑成就， PHEU -机器学习（ML）的理想数据集，并与其他多学科科学家共享。然而，在这方面， 完整CASAH数据集中的间隙（例如，未处理的数据，未缩放的变量），并在数据文档中充当 将其用于ML并通过NIH支持的数据存储库共享的障碍。因此，这一年ML的目标 数据准备管理补充是准备（整理、清理、记录、测试和共享）完整的CASAH 数据集（最终将跨越20年和10波数据收集），用于ML应用程序和共享 与一系列多学科的科学家根据美国国立卫生研究院的目标，以促进我们的健康知识 艾滋病毒感染者的健康状况和社会决定因素。在本提案中，我们补充说， ML数据分析方法、数据安全性和数据可传输性方面的专业知识。确保可运输性 CASAH数据将允许对非艾滋病毒人群进行跨队列研究（例如，全国纵向研究 青少年到成人健康;博里夸青年研究; ABCT）这将增强我们识别多模式的能力 关键发展阶段的健康决定因素-急需的知识， 艾滋病毒感染者、慢性病患者和受一系列健康差距影响的青年人的干预措施。

For the past 18 years, CASAH has followed 340 predominantly Black and Latino/a youth with perinatally acquired HIV (PHIV) and youth perinatally HIV exposed but infected (PHEU) – enrolled at ages 9-16 years from vulnerable communities in New York City – documenting health risk and resilience across childhood, adolescence, and emerging adulthood. Now in its fourth competing continuation (R01 MH69133-19), CASAH4, as it is known, is following this cohort through young adulthood (YA; 20s-early 30s). CASAH has made significant contributions to research on health risk and resilience and the social determinants of these outcomes in PHIV and PHEU youth with over 125 publications and 80 scientific presentations, and has directly informed mental-health and HIV- prevention interventions and service systems in the US and abroad. CASAH is guided by Social Action Theory (SAT), and CASAH4 specifically examines: 1) the impact of HIV infection on behavioral health outcomes (e.g., mental health, sexual risk, substance use, adherence) and achievement of adult milestones (e.g., education, vocation, independence); 2) how SAT-informed risk and protective factors affect YA behavioral health and achievement of adult milestones; 3) trajectories of behavioral health across adolescence and young adulthood and SAT-informed predictors of these trajectories; and 4) behavioral health outcomes and their SAT-informed predictors among youth across global cohorts (e.g. US, Thailand, South Africa). CASAH4 has added biomedical health indicators (inflammation and immune activation biomarkers associated with psychiatric and neurocognitive function) to HIV RNA viral load and CD4+ cell count data already collected. With its ongoing and historical work, CASAH has one of the most comprehensive longitudinal datasets on mental health, alcohol/substance use, behavioral health, as well as milestone achievement among adolescents and young adults living with PHIV or PHEU – a dataset ideal for machine learning (ML) and sharing with other multidisciplinary scientists. However, gaps in the full CASAH dataset (e.g., unprocessed data, unscaled variables) and in data documentation act as barriers to using it for ML and sharing it via NIH-supported data repositories. Thus, the aims of this one-year ML data readiness administrative supplement are to prepare (collate, clean, document, test and share) the full CASAH dataset (which will ultimately span 20 years and 10 waves of data collection) for use in ML applications and sharing with a range of multidisciplinary scientists in accordance with the NIH goals to advance our knowledge of health outcomes and social determinants of health in vulnerable young people affected by HIV. In this proposal, we add expertise in ML data analytic approaches, data security and data transportability. Ensuring the transportability of CASAH data will allow for cross-cohort studies with non-HIV populations (e.g., The National Longitudinal Study of Adolescent to Adult Health; Boriqua Youth Study; ABCT) which will strengthen our ability to identify multimodal determinants of health across critical developmental stages – much needed knowledge to develop evidence-based interventions for youth with HIV, chronic health conditions, and affected by a range of health disparities.