Pathways to Successful Aging Among Perinatally HIV-infected and Exposed Young Adults: Risk, Resilience, and the Role of Perinatal HIV Infection

在过去的18年里，CASAH跟踪了340名患有围产期后天获得性疾病的年轻人，其中主要是黑人和拉丁裔 艾滋病毒(PHIV)和围产期暴露于艾滋病毒但被感染(PHEU)的青年--9-16岁登记在册 纽约市的社区-记录儿童、青春期和 即将进入成年期。现在，在它的第四个竞争延续(R01 MH69133-19)中，CASAH4，正如它所知的那样，是 跟随这个队列，直到成年(YA；20岁-30岁出头)。CASAH在以下方面做出了重大贡献 HIV和PHEU青年的健康风险和复原力及其结果的社会决定因素研究 拥有超过125份出版物和80份科学报告，并直接为心理健康和艾滋病毒- 美国和国外的预防干预和服务体系。CASAH以社会行动理论为指导 (SAT)，并且CASAH4具体检查：1)艾滋病毒感染对行为健康结果的影响(例如， 心理健康，性风险，药物使用，坚持)和成人里程碑的成就(例如，教育， 职业、独立性)；2)SAT知情的风险和保护因素如何影响YA行为健康和 成人里程碑的成就；3)青春期和青春期的行为健康轨迹 这些轨迹的SAT信息预测因子；以及4)行为健康结果及其SAT信息 全球人群(例如美国、泰国、南非)青年中的预测因素。CASAH4增加了生物医学 健康指标(与精神和神经认知相关的炎症和免疫激活生物标志物 功能)到已经收集的HIV RNA病毒载量和CD4+细胞计数数据。其持续的和历史性的工作， CASAH拥有最全面的关于精神健康、酒精/药物使用的纵向数据集， 行为健康，以及感染艾滋病毒或艾滋病的青少年和年轻人取得的里程碑式成就 PHEU-机器学习(ML)和与其他多学科科学家共享的理想数据集。然而， 完整CASAH数据集(例如，未处理的数据、未按比例调整的变量)和数据文档中的差距起到以下作用 在ML中使用它并通过NIH支持的数据存储库共享它的障碍。因此，这个为期一年的ML的目标是 数据就绪性行政补充是准备(整理、清理、记录、测试和共享)完整的CASAH 用于ML应用程序和共享的数据集(最终将跨越20年和10波数据收集) 根据美国国立卫生研究院的目标，与一系列多学科的科学家一起推进我们对健康的了解 受艾滋病毒影响的弱势青年的健康结果和社会决定因素。在这份提案中，我们增加了 精通ML数据分析方法、数据安全性和数据可传输性。确保产品的可运输性 CASAH数据将允许对非艾滋病毒人群进行交叉队列研究(例如，国家纵向研究 青少年到成人健康；博利奎青年研究；ABCT)将增强我们识别多式联运的能力 关键发育阶段的健康决定因素--发展循证医学亟需的知识 针对艾滋病毒携带者、慢性健康状况和受一系列健康差距影响的青年的干预措施。

For the past 18 years, CASAH has followed 340 predominantly Black and Latino/a youth with perinatally acquired HIV (PHIV) and youth perinatally HIV exposed but infected (PHEU) – enrolled at ages 9-16 years from vulnerable communities in New York City – documenting health risk and resilience across childhood, adolescence, and emerging adulthood. Now in its fourth competing continuation (R01 MH69133-19), CASAH4, as it is known, is following this cohort through young adulthood (YA; 20s-early 30s). CASAH has made significant contributions to research on health risk and resilience and the social determinants of these outcomes in PHIV and PHEU youth with over 125 publications and 80 scientific presentations, and has directly informed mental-health and HIV- prevention interventions and service systems in the US and abroad. CASAH is guided by Social Action Theory (SAT), and CASAH4 specifically examines: 1) the impact of HIV infection on behavioral health outcomes (e.g., mental health, sexual risk, substance use, adherence) and achievement of adult milestones (e.g., education, vocation, independence); 2) how SAT-informed risk and protective factors affect YA behavioral health and achievement of adult milestones; 3) trajectories of behavioral health across adolescence and young adulthood and SAT-informed predictors of these trajectories; and 4) behavioral health outcomes and their SAT-informed predictors among youth across global cohorts (e.g. US, Thailand, South Africa). CASAH4 has added biomedical health indicators (inflammation and immune activation biomarkers associated with psychiatric and neurocognitive function) to HIV RNA viral load and CD4+ cell count data already collected. With its ongoing and historical work, CASAH has one of the most comprehensive longitudinal datasets on mental health, alcohol/substance use, behavioral health, as well as milestone achievement among adolescents and young adults living with PHIV or PHEU – a dataset ideal for machine learning (ML) and sharing with other multidisciplinary scientists. However, gaps in the full CASAH dataset (e.g., unprocessed data, unscaled variables) and in data documentation act as barriers to using it for ML and sharing it via NIH-supported data repositories. Thus, the aims of this one-year ML data readiness administrative supplement are to prepare (collate, clean, document, test and share) the full CASAH dataset (which will ultimately span 20 years and 10 waves of data collection) for use in ML applications and sharing with a range of multidisciplinary scientists in accordance with the NIH goals to advance our knowledge of health outcomes and social determinants of health in vulnerable young people affected by HIV. In this proposal, we add expertise in ML data analytic approaches, data security and data transportability. Ensuring the transportability of CASAH data will allow for cross-cohort studies with non-HIV populations (e.g., The National Longitudinal Study of Adolescent to Adult Health; Boriqua Youth Study; ABCT) which will strengthen our ability to identify multimodal determinants of health across critical developmental stages – much needed knowledge to develop evidence-based interventions for youth with HIV, chronic health conditions, and affected by a range of health disparities.