Using Biomarkers to Understand the HIV Epidemic in a Community Sample of Black MSM

 描述(由申请人提供)：与男性发生性行为的黑人男性(BMSM)不成比例地背负着新的和现有的艾滋病毒感染。这在很大程度上是由于艾滋病毒护理连续体的差异，这是一种多阶段护理模式，从诊断开始，然后是联系和保留护理，需要开出抗逆转录病毒疗法的处方并坚持治疗，最后是病毒抑制。最后一个阶段不仅代表着对个人健康所必需的艾滋病毒疾病的控制，而且还使实际上有可能消除通过性传播将艾滋病毒传染给他人；艾滋病毒治疗方面的差距就是艾滋病毒预防方面的差距。由于这些是影响感染动态的护理连续体的生物标志物，因此需要用有关CD4计数、抗逆转录病毒药物使用和病毒抑制的信息来补充行为数据。我们目前正在随机收集参加黑人骄傲活动(“黑人骄傲研究”，R01NR013865，PI：Stall)的BMSM样本，以了解与连续谱差异相关的因素。最近的科学进步表明，有必要利用生物标记物来加强行为研究。自我报告可能会错误地将BMSM中未知的艾滋病毒感染分类；两项研究表明，许多原本被归类为未知感染的人实际上具有可检测到的ART水平或被病毒抑制。如果诊断不是驱动差异的连续阶段，我们可能是在低效地投资资源。我们还必须探索自我报告可能在多大程度上错误地将BMSM分类为艾滋病毒护理连续体的其他阶段。根据这些发现和我们的理论框架，我们假设抑制病毒抑制的相同因素(例如，联集生产、艾滋病毒污名)是相同的，它们影响自我报告和生物学数据之间的不一致性。我们建议使用干血斑点(DBS)实验室技术通过从BMSM采集微量血液来分析CD4、ART和病毒载量。这项研究将针对以下三个具体目标：(1)使用自我报告和生物学数据来检验可操作的HIV护理连续体地位的差异；(2)使用行为和生物学结果数据相结合的方法来探索HIV关怀连续体地位及其相关因素；以及(3)描述在BMSM社区样本中使用DBS的可接受性。这些目标的完成将产生迄今为止对BMSM中护理连续体的最全面的了解，并将有助于为寻求使用行为和生物数据组合的研究努力提供最佳实践。这项研究将最大限度地提高BMSM的干预成功，因为它允许自信地识别艾滋病毒差异的来源，从而有能力针对这些差异。

 DESCRIPTION (provided by applicant): Black men who have sex with men (BMSM) are disproportionately burdened with new and existing HIV infection. This is largely attributable to disparities in the HIV care continuum, a multistage care model that starts with diagnosis, is followed by linkage and retention in care, requires the prescription of and adherence to antiretroviral therapy (ART), and ends with viral suppression. Not only does the last stage represent control of HIV disease necessary for the health of individuals, it also makes possible the virtual elimination of sexual transmission of HIV infection to others; disparities in HIV treatment are disparities in HIV prevention. Supplementing behavioral data with information on CD4 count, ART use, and viral suppression are needed since these are biological markers of the care continuum that influence infection dynamics. We are currently collecting a random sample of BMSM attending Black Pride events (the "Black Pride study," R01NR013865, PI: Stall) to understand factors associated with continuum disparities. Recent scientific advances suggest the need to enhance behavioral research with biological markers. Self-report may misclassify unknown HIV infection among BMSM; two studies demonstrate many who would have otherwise been classified as having unknown infection actually had detectable levels of ART or were virally suppressed. We may be inefficiently investing resources if diagnosis is not the continuum stage driving disparities. We must also explore the extent to which self-report may misclassify BMSM in other stages of the HIV care continuum. With these findings, and our theoretical framework, we hypothesize that the same factors that inhibit viral suppression (e.g., syndemic production, HIV stigma) are the same that influence discordance between self-report and biological data. We propose the use of dried blood spot (DBS) lab techniques to analyze CD4, ART, and viral load by collecting minute quantities of blood from BMSM. This study will address the following three Specific Aims:(1) Examine differences in operationalizing HIV care continuum position using self-report and biological data, (2) Explore HIV care continuum position and associated factors using a combination of behavioral and biological outcome data, and (3) Describe acceptability of using DBS in a community sample of BMSM. Completion of these aims will generate the most comprehensive understanding of the care continuum among BMSM to date, and will help inform best practices for research endeavors that seek to employ a combination of behavioral and biological data. This research will maximize intervention success for BMSM by allowing for the confident identification, and consequently the ability to target, sources of HIV disparities.