Multilevel Influences on HIV and Substance Use in a YMSM cohort

在这个竞争性的更新中，我们建议继续对有性行为的年轻男性进行最大规模的队列研究。 曾与人交往，RADAR研究于2014年启动，旨在提供对风险的关键见解 和保护因素，并确定在实施一项预防和控制艾滋病毒/艾滋病方案方面的促进因素和障碍， 有效的战略来结束这一流行病。RADAR反映了美国的艾滋病毒流行情况;它侧重于年龄与 艾滋病毒发病率最高的国家，少数艾滋病毒不平等群体的代表性特别高（黑人38%， 拉丁裔），位于芝加哥，一个城市中心的艾滋病毒和毒品流行病（即，库克县是 艾滋病发病率第四（2017年）。在我们最初的赠款期间，我们在招聘方面非常富有成效 （N> 1，200），保留率（>80%），科学产出（40+出版物），培训未来的学者，并担任 创新研究平台（25+相关研究;通过NIDA C3 PNO联盟的7个概念）。 YMSM占青少年和年轻人中所有新艾滋病毒诊断的近70% 虽然所有其他风险群体的发病率都在下降，但在美国， YMSM的颜色在不断发展的预防和治疗选择的时代，YMSM仍然显示出不足的PrEP 利用率和艾滋病毒护理级联下降率很高。物质使用和少数民族压力源， 相关的社会、结构和生物过程是造成差距的关键因素。响应于 RFA-DA-20-005我们提出了一个复杂的多水平研究设计，其中我们将加强队列研究， 到2020年，将有300名新的16-20奥尔兹，并继续跟踪现有的队列成员。在这次更新中，我们将 回答关于YMSM中艾滋病毒和药物使用流行的关键新问题。首先（目标1），我们将 保持对药物使用，艾滋病毒风险/预防行为和护理连续参与的新趋势的脉搏。 我们将绘制YMSM药物使用到成年的发展轨迹，重点关注如何使用 轨迹和转变与毒品后果有关。此外，多个样本的招募 16-20奥尔兹（2008年，2011年，2015年，2020年）允许我们解开历史（例如，PrEP的出现;大麻 合法化）以及药物使用、艾滋病毒风险和护理方面的发展变化。下一步（目标2），我们将继续 招募新的伴侣我们将通过纵向检查密钥来扩展我们先前的工作， 二元过程在物质使用问题和艾滋病毒风险行为的发展中所起的作用， 耦合YMSM之间的传输。第三（目标3），我们将在高水平的 RADAR队列中的全身性炎症，无论HIV状态如何， 开始预测HIV+和HIV- YMSM的晚年发病率。最后（目标4），雷达将 继续向我们的生物行为特征库中添加标本和数据，为以下方面提供平台： 高影响力的科学雷达是一个独特的多层次和纵向研究不同的YMSM-其延续 将提供关键数据，为结束艾滋病毒流行的战略提供信息。

In this competing renewal, we propose to continue the largest cohort study of young men who have sex with men (YMSM) ever conducted. The RADAR study was launched in 2014 to provide critical insights into risk and protective factors for HIV and drug use, and to identify facilitators and barriers to the implementation of an effective strategy to end the epidemic. RADAR is reflective of the US HIV epidemic; it focuses on the ages with the highest HIV incidence, has exceptional representation of minority HIV disparity groups (38% black, 30% Latino), and is located in Chicago, an urban epicenter of the HIV and drug epidemics (i.e., Cook County was 4th in HIV incidence-2017). During our initial grant period, we were extremely productive in recruitment (N>1,200), retention (>80%), scientific outputs (40+ publications), training future scholars, and serving as a platform for innovative research (25+ connected studies; 7 concepts via NIDA C3PNO consortium). YMSM account for nearly 70% of all new HIV diagnoses among adolescents and young adults each year in the U.S. While all other risk groups have declining incidence, dramatic increases continue among YMSM of color. In an era of evolving prevention and treatment options, YMSM still show insufficient PrEP utilization and fall off the HIV care cascade at high rates. Substance use and minority stressors, with associated social, structural, and biological processes, are key factors that drive disparities. In response to RFA-DA-20-005 we propose a sophisticated multilevel research design, in which we will enhance the cohort in 2020 with 300 new 16-20 year olds and continue to follow existing cohort members. In this renewal, we will answer critical new questions about the HIV and substance use epidemics in YMSM. First (Aim 1), we will keep a pulse on emerging trends in drug use, HIV risk/preventive behaviors, and care continuum engagement. We will chart YMSM developmental trajectories of drug use into adulthood, with a novel focus on how use trajectories and transitions are associated with drug consequences. Further, enrollment of multiple samples of 16-20 year olds (2008, 2011, 2015, 2020) allows us to disentangle historical (e.g., advent of PrEP; marijuana legalization) and developmental changes in substance use, HIV risk and care. Next (Aim 2), we will continue to enroll cohort members’ new serious partners. We will extend our prior work by longitudinally examining the key role that dyadic processes play in the development of substance use problems and HIV risk behaviors and transmission among coupled YMSM. Third (Aim 3), we will build on our provocative findings of high levels of systemic inflammation in the RADAR cohort regardless of HIV status by collecting pathogenic biomarkers of substance use to begin forecasting later-life morbidities for HIV+ and HIV- YMSM. Finally (Aim 4), RADAR will continue to add specimens and data to our well-characterized biobehavioral repository to provide a platform for high-impact science. RADAR is a unique multilevel and longitudinal study of diverse YMSM—its continuation will provide critical data to inform strategies to end the HIV epidemic.