Keeping it LITE: Exploring HIV Risk in Vulnerable Youth with Limited Interaction

项目总结/摘要 作为对RFA-AI-16-031的回应，我们提出了“保持低调：探索脆弱青年的艾滋病毒风险， 有限的互动，”这将使用电子招聘，使年轻的男男性接触者和TGW在一个创新的 队列研究旨在监测艾滋病毒风险和预防行为，并探索 以最小的参与来影响行为和态度。这种低交互策略将使我们能够 描述整个芝加哥地区的持续感染趋势，并描述个人和社区水平的特征 增加HIV风险的因素，同时最大限度地减少参与研究和 本身此外，鉴于艾滋病毒预防技术的迅速发展，我们将利用我们的大型， 未感染艾滋病毒的青少年的纵向队列，以监测PrEP的获取，吸收和坚持时间。更 对那些在队列中登记时感染艾滋病毒的人以及那些“普遍阳性”的人进行了深入研究， 基线，利用创新的社会网络和社会动态分析，将确定集群的正在进行的积极 传播和测试新的方法的可行性，以针对那些在最高的生物医学预防 风险亚组。随着纵向数据的积累，我们将做好准备，设计和试点测试虚拟 为年轻男男性接触者和变性女同性恋者提供最佳艾滋病毒预防战略。我们提出的方法保证了 最大可能导致艾滋病毒预防取得有意义的进展，包括开发工具 和战略，易于实施和可扩展的出口到其他社区遭受类似的 艾滋病毒感染的流行。我们提出了以下具体目标：目标1：招募和保留一个大的队列 13-34岁男男性接触者和女同性恋者（3年内1000人/年）感染艾滋病毒的高风险， 以及通过社交媒体和有针对性的电子广告提供具有成本效益的招生策略。目标1a： 在研究过程中采集至少230例HIV血清转化，之前采集300例 未确诊的艾滋病毒感染青年。目标1b：探索行为、场所、社会人口特征和 社会生态学影响预测艾滋病毒感染。目标2（UH 3阶段）：表征真实世界的PrEP 在纵向队列中招募和保留的年轻MSM和TGW中使用，并探索个体， 提供者和社区水平的PrEP摄取，PrEP依从性和PrEP中止的预测因素。目标3 (UH3阶段）：使用社会网络和社会动态分析来识别正在进行的 艾滋病毒血清转换者的年轻男男性行为者和TGW在队列中登记的传播网络。目标3a： 提供数据，以优化设计和确定加强的伙伴服务和新的生物医学预防措施 战略布局目的4（UH 3阶段）：描述新诊断的年轻MSM/TGW中的艾滋病毒护理连续性 目标4a：确定最终病毒抑制的个人、网络、社区和结构预测因素。

PROJECT SUMMARY/ABSTRACT In response to RFA-AI-16-031, we propose “Keeping it LITE: Exploring HIV Risk in Vulnerable Youth with Limited Interaction,” which will use electronic recruitment to engage young MSM and TGW in an innovative cohort designed to monitor HIV risk and prevention behaviors and explore the socioecological factors that influence behavior and attitudes with minimal engagement. This low-interaction strategy will allow us to describe ongoing infection trends across the Chicago area and characterize individual and community level factors that enhance HIV risk, while minimizing the potential intervention effects of study participation in and of itself. Further, given the rapidly advancing state of HIV prevention technologies, we will use our large, longitudinal cohort of HIV-uninfected youth to monitor PrEP access, uptake and adherence across time. More intensive study of those who acquire HIV while enrolled in the cohort, as well as those “prevalent positives” at baseline, using innovative social network and phylodynamic analysis, will identify clusters of ongoing active transmission and test the feasibility of novel approaches to target biomedical prevention to those in the highest risk subgroups. As the longitudinal data accumulate, we will be well-poised to design and pilot test virtual strategies for optimal HIV prevention for young MSM and TGW. Our proposed methodologies assure the maximum likelihood of leading to meaningful advances in HIV prevention including the development of tools and strategies that are easily implemented and scalable for export to other communities suffering from similar epidemics of HIV infection. We propose the following specific aims: Aim 1: To enroll and retain a large cohort of 13-34 year-old MSM and TGW (1000/year over 3 year) at high risk of HIV acquisition using tested, novel and cost-effective enrollment strategies through social media and targeted electronic advertisement. Aim 1a: To capture at least 230 HIV seroconversions occurring over the course of the study and 300 previously undiagnosed HIV-infected youth. Aim 1b: To explore behaviors, venues, sociodemographic characteristics and socioecological influences that predict HIV acquisition. Aim 2 (UH3 Stage): To characterize real-world PrEP use among young MSM and TGW enrolled and retained in a longitudinal cohort and explore the individual, provider and community-level predictors of PrEP uptake, PrEP adherence and PrEP discontinuation. Aim 3 (UH3 Stage): To use social network and phylodynamic analysis to identify characteristics of ongoing transmission networks of HIV seroconverters among young MSM and TGW enrolled in the cohort. Aim 3a: To provide data for optimal design and targeting of enhanced partner services and novel biomedical prevention strategies. Aim 4 (UH3 Stage): To describe the HIV care continuum among newly diagnosed young MSM/TGW Aim 4a: Identify individual, network, community and structural predictors of eventual viral suppression.