Comparative Efficacy of HIV-Prevention among Youth with Mental Health Needs

描述(由申请者提供)：这个指导研究科学家职业发展奖将为David Barker博士提供有针对性的培训，使他能够利用现代统计建模方法确定有希望的干预领域，并与多学科团队合作，为青少年实施有效的艾滋病毒预防计划。有效传播现有预防方案的一个挑战是对谁对特定方案作出反应或不对其作出反应的了解有限。向政策制定者和项目主管提供此类信息将有助于使现有的预防项目与目标人群的需求相匹配。确定哪种预防方案对哪些青少年亚群最有效，需要复杂的统计建模和大样本来识别和描述这些亚群。合并不同研究是增加单个试验样本量的一种经济有效的方法。然而，合并数据会带来复杂性，因为研究的设计方式以及关键结果的收集、分析和解释方式存在差异。这项拟议的研究将NIH资助的五项针对年轻人的艾滋病毒预防计划试验的数据与心理健康问题相结合，以比较这些计划的有效性，并确定哪些年轻人对当前的计划有反应或没有反应。拟议的研究有助于巴克博士实现他的职业生涯和培训目标：(1)学习现代建模方法，以解决组合多个数据集时出现的复杂数据结构；(2)学习在整合多个临床试验的数据时得出因果推理的方法；(3)学习比较未在“面对面”试验中测试的预防计划的有效性的方法；(4)将他在艾滋病毒风险预防方面的培训扩展到美国国家艾滋病毒/艾滋病战略中确定的关键易感人群，即使用物质的人群和性少数群体，(5)制定一项研究计划，利用现有数据确定改善预防工作的有希望的领域，以及(6)与参与艾滋病毒预防的著名科学家开展合作，以开发高质量的研究手稿和赠款。拟议研究的具体目标是(1)建立一个数据库，将来自NIH资助的5项预期艾滋病毒预防试验的数据联系起来，(2)通过联合建模青春期性风险行为的多个维度，在5项试验中应用一致的分析，(3)比较当前针对青少年的预防计划的有效性，以及(4)识别和描述对每种预防方法有反应或无反应的有心理健康担忧的青少年亚群。这些目标将通过使用通过K23机制学到的技能来解决组合多个预防试验的数据的分析复杂性来实现。培训将包括授课课程、研讨会和由一组专家在现代分析方法和艾滋病毒预防方面的指导。辅导将包括量身定做的阅读作业，定期面对面的会议，指导研究，以及合作项目和手稿。通过K23应用程序接受的培训将使巴克博士能够与著名的艾滋病毒预防科学家合作，开展受资助的研究，重点是利用现代分析建模技术来改进艾滋病毒预防工作。

DESCRIPTION (provided by applicant): This Mentored Research Scientist Career Development Award will provide Dr. David Barker with focused training to enable him to leverage modern statistical modeling methods in identifying promising areas of intervention, and to collaborate with multidisciplinary teams to implement effective HIV-prevention programs for adolescents and young adults. One challenge to the effective dissemination of existing prevention programs is the limited understanding of who responds or does not respond to a given program. Providing such information to policy makers and program directors will help match existing prevention programs to the needs of target populations. Identifying which prevention program works best for which subgroups of youth requires sophisticated statistical modeling and large samples to identify and describe the subgroups. Combining across studies is a cost-effective way to increase the sample size of individual trials. However, combining data introduces complexity due to differences in how studies are designed and in how key outcomes are collected, analyzed and interpreted. The proposed research combines data from five NIH-funded trials of HIV-prevention programs for youth with mental health concerns to compare the efficacy of the programs and identify which youth respond or do not respond to current programs. The proposed research assists Dr. Barker in achieving his career and training goals to: (1) learn modern modeling approaches to address complex data structures that arise when combining multiple datasets, (2) learn methods for drawing causal inferences when integrating data across multiple clinical trials, (3) learn methods to compare the efficacy of prevention programs not tested in a "head-to-head" trial, (4) extend his training in HIV-risk prevention to key vulnerable populations identified in the National HIV/AIDS Strategy for the United States, namely substance using populations and sexual minority populations, (5) develop a program of research that utilizes existing data to identify promising areas for improving prevention efforts, and (6) develop collaborations with prominent scientist involved in HIV-prevention to develop high-quality research manuscripts and grants. The specific aims of the proposed research are to (1) build a database that links data from 5 NIH-funded prospective HIV-prevention trials, (2) Apply consistent analyses across the 5 trials by jointly modeling the multiple dimensions of adolescent sexual risk behavior, (3) compare the efficacy of current prevention programs for youth with mental health concerns, and (4) Identify and describe subgroups of adolescents with mental health concerns who responded or did not respond to each prevention approach. These aims will be achieved by using the skills learned through this K23 mechanism to address the analytic complexities of combining data across multiple prevention trials. Training will include a combination of didactic coursework, workshops, and mentoring by a team of experts in modern analytic approaches and HIV-prevention. The mentoring will include tailored reading assignments, regular face-to-face meetings, mentored research, and collaborative projects and manuscripts. The training received through this K23 application will place Dr. Barker in a position to collaborate with prominent HIV-prevention scientists in funded research focused on leveraging modern analytic modeling techniques to improve HIV-prevention efforts.