Examining Modifiable Psychosocial Predictors of HIV Seroconversion in a Large Nationwide Cohort of High Risk Men

项目摘要 同性恋、双性恋和其他与男性发生性关系的男性(GBMSM)在美国仍然是一个人口群体，对他们来说 艾滋病毒的负担很高，而且不成比例，特别是在年轻的GBMSM和有色人种GBMSM中， 尽管进行了数十年的艾滋病毒预防研究以遏制这一流行病，但世卫组织的艾滋病毒发病率仍在继续上升。 然而，即使在这些最高风险群体中，感染风险也不相等，这项研究的目标是 为了更好地了解哪些因素区分了艾滋病毒感染的风险水平。迄今为止的研究表明， 这种不成比例的负担可能会因#年人口面临的心理社会差距而加剧。 综合体的形式和性少数群体的压力。然而，对这些因素的研究一直受到 将艾滋病毒感染的风险作为艾滋病毒的危险行为或艾滋病毒的横截面流行来运作，使 感染的实际脆弱性和时间相关性即使不是不可能，也很难确定。我们是 提交本申请以响应RFA-AI-16-031针对流行病学(LITE)的有限互动 艾滋病毒高级预防(UG3/UH3)。我们建议招募和招收一大批不同的 在美国和波多黎各，大约8,000名年龄在16岁及以上的GBMSM感染风险很高。 我们将利用移动性网络应用程序(“移动应用程序”)来识别和登记这两名男性 允许快速高效的招聘，因为这些应用程序的受欢迎程度迅速上升，通过研究 显示使用移动应用程序的男性感染艾滋病毒的风险高于GBMSM 通过其他方式招募的。利用这一群体，我们将努力实现三个主要目标：(1)我们将 确定艾滋病毒流行率和直肠性传播感染流行率(性传播感染；淋病和 衣原体)，并随后确定这些男性中艾滋病毒和直肠性传播感染的发病率12 之后的几个月；(2)我们将利用合并症、少数民族应激和其他相关的基线水平 心理社会风险因素：为那些导致艾滋病毒风险增加的可改变因素建立模型 血清转换(即发病率)以及直肠性传播感染；(3)我们将利用该模型针对 队列中艾滋病毒血清转换风险最高的四分位数，此后每6个月跟踪一次 再用两年的时间来检验预测艾滋病毒血清转换的预测效用以及 是时候进行血清转换了。为实际HIV开发可修改的心理社会风险因素模型 血清转换和随后在前瞻性设计中测试其可靠性和有效性具有很高的潜力 改进下一代艾滋病毒预防干预措施，旨在缩小这一人群的差距。

Project Summary Gay, bisexual and other men who have sex with men (GBMSM) remain a population in the U.S. for whom the burden of HIV is high and disproportionate, particularly among younger GBMSM and GBMSM of color, for whom HIV incidence continues to rise despite decades of HIV prevention research to curb the epidemic. However, even among these highest risk groups, risk for infection is not equivalent and the goal of this study is to better understand what factors differentiate levels of risk for HIV infection. Research to date suggests that this disproportionate burden is likely to be exacerbated by psychosocial disparities faced by this population in the form of syndemics and sexual minority stress. However, research on these factors has been limited by a focus on risk for HIV infection operationalized as risk behavior or cross-sectional prevalence of HIV, making actual vulnerability to infection and temporal associations difficult, if not impossible, to determine. We are submitting this application in response to RFA-AI-16-031 Limited Interaction Targeted Epidemiology (LITE) to Advance HIV Prevention (UG3/UH3). We propose to recruit and enroll a large and diverse cohort of approximately 8,000 GBMSM ages 16 and older in the U.S. and Puerto Rico who are at high risk for infection. We will utilize mobile sexual networking applications (“mobile apps”) to identify and enroll these men both to allow for rapid and efficient recruitment and because these apps rapidly increasing in popularity, with research demonstrating that men who use mobile apps are at higher levels of risk for HIV infection than GBMSM recruited through other means. Using this cohort, we will work to achieve three primary aims: (1) we will establish HIV prevalence as well as prevalence of rectal sexually transmitted infections (STIs; gonorrhea and chlamydia) at baseline and subsequently establish rates of HIV and rectal STI incidence among these men 12 months thereafter; (2) we will utilize baseline levels of syndemic, minority stress, and other relevant psychosocial risk factors to develop a model of those modifiable factors that contribute to increased risk for HIV seroconversion (i.e., incidence) as well as rectal STI infection; (3) we will utilize the model to target men in the highest quartile of risk for HIV seroconversion in the cohort and follow them every 6 months thereafter for an additional two years to examine the predictive utility in prospectively predicting HIV seroconversion as well as time to seroconversion. Developing a model of modifiable psychosocial risk factors for actual HIV seroconversion and subsequently testing its reliability and validity in a prospective design has high potential to improve the next generation of HIV prevention interventions aimed at reducing disparities for this population.