Young Men of Color Who Have Sex with Men Cohort Study

 描述：U01-对与男性发生性行为的有色人种青年进行的队列研究在艾滋病毒流行的这40个十年中，我们继续看到美国每年有50,000人新感染，特别是在黑人/非裔美国人和拉丁裔与男性发生性行为的年轻男性中(有色人种青年男性行为者)，他们现在占黑人/非裔美国人MSM新感染的60%，占拉美裔MSM新感染的45%。黑人/非裔美国YMSM的艾滋病毒血清阳性的可能性是其他YMSM的五倍，患有未诊断的HIV感染的可能性是其他YMSM的七倍，被诊断为性传播感染的可能性是其他YMSM的45%。有色人种的YMSM也是最不可能寻求并继续接受艾滋病毒/艾滋病护理的人，当他们确实寻求护理时，他们通常已经患有晚期艾滋病毒疾病。在开始抗逆转录病毒疗法(ART)的青年中，54%的人将实现病毒抑制；不幸的是，57%的人不会继续接受护理，只有不到6%的人将保持病毒抑制状态。改变这一流行病的进程将需要一种截然不同的预防方法。因此，我们建议对450名有色人种青年男性接触者进行大规模和多样化的纵向研究，以预防新的艾滋病毒感染，减少传播，并通过专注于成功参与护理来减少与艾滋病毒/艾滋病相关的差异。在艾滋病毒连续护理和预防范式(即寻求、检测、治疗和保留在护理中)和风险综合理论的基础上，我们将使用混合方法研究设计，在基线和每六个月收集和分析定量、定性和生物指标。参与者将从公共场所、艾滋病毒检测地点和艾滋病毒/艾滋病诊所招募，采用随机概率和有目的的抽样设计。所有参与者都将被跟踪，以确保保留率达到90%或更高，这是一个可行的目标，因为我们在健康青年男性(HYM)研究中的保留率为94%。具体目标是：1)更好地理解和操作界定什么是联系、参与、保持护理(初级保健和艾滋病毒/艾滋病治疗)和坚持有色人种的手段；2)确定和监测有色人种青年男性接触者使用酒精和非法药物的情况；艾滋病毒检测和预防服务的利用；艾滋病毒和性传播感染的发病率；保险状况和获得保健服务的机会，包括初级保健和艾滋病毒/艾滋病治疗服务；参与和利用保健和艾滋病毒/艾滋病治疗服务；保持艾滋病毒/艾滋病护理并坚持抗逆转录病毒疗法；以及使用生物医学干预措施，如PrEP和PEP；以及3)确定艾滋病毒护理和预防连续过程中的障碍/促进者。这项拟议的研究建立在NIH资助的近20年研究的基础上，该研究团队专注于这一群体和其他高危青年人群。

 DESCRIPTION: U01 - Cohort Study with Young Men of Color who have Sex with Men In this fourth decade of the HIV epidemic, we continue to see 50,000 new infections annually in the U.S., particularly among Black/African American and Latino young men who have sex with men (YMSM of color), who now account for 60% of new infections among Black/African American MSM and 45% of new infections among Latino MSM. Black/African American YMSM remain five times more likely to be HIV seropositive, seven times more likely to have an undiagnosed HIV infection, and 45% more likely to be diagnosed with an STI than other YMSM. YMSM of color are also the least likely to seek and remain in HIV/AIDS care, and when they do seek care, they typically already have advanced HIV disease. Among youth who initiate antiretroviral therapy (ART), 54% will achieve viral suppression; unfortunately 57% will not be retained in care and less than 6% will remain virally suppressed. Changing the course of this epidemic is going to require a dramatically different approach to prevention. We are therefore proposing to conduct longitudinal research with a large and diverse cohort of 450 YMSM of color in order to prevent new HIV infections, reduce transmission, and reduce HIV/AIDS-related disparities by focusing on successful engagement in care. Building on the HIV Continuum of Care and Prevention paradigm (i.e., seek, test, treat, and retain in care) and the Syndemic Theory of Risk, we will use a mixed-methods study design to collect and analytically triangulate quantitative, qualitative, and biological measures at baseline and every six months. Participants will be recruited from public venues, HIV test sites, and HIV/AIDS clinics using randomized probability and purposeful sampling designs. All participants will be tracked to ensure a retention rate of 90% or better, which is a feasible target given our retention rates of 94% in the Healthy Young Men's (HYM) Study. The specific aims are to 1) better understand and operationally define what linkage, engagement, retention to care (both primary health and HIV/AIDS treatment) and adherence means to HIV- and HIV+ YMSM of color; 2) characterize and monitor over time YMSM of color's use of alcohol and illicit drugs; utilization of HIV testing and prevention services; incidence of HIV and STIs; insurance status and access to health care services, including primary care and HIV/AIDS treatment services; engagement in and utilization of health care and HIV/AIDS treatment services; retention in HIV/AIDS care and adherence to ART; and utilization of biomedical interventions, such as PrEP and PEP; and 3) identify barriers/facilitator of engagement along the HIV Continuum of Care and Prevention. The proposed research builds on close to two decades of NIH-funded research by our team focused on this and other high-risk youth populations.