Multilevel Influences on HIV and Substance Use in a YMSM cohort

YMSM 队列中对 HIV 和药物使用的多层次影响

• 批准号: 10348186
• 负责人: Brian Mustanski
• 金额: $ 273.96万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-15 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10348186
• 关键词: 20 year old; AIDS prevention; Address; Adolescence; Adolescent and Young Adult; Adult; Age; Age-Years; Aging; Agreement; Area; Behavior; Biological; Biological Markers; Biological Process; Caring; Cells; Characteristics; Chicago; Clinical; Cohort Studies; Continuity of Patient Care; County; Coupled; Data; Development; Diagnosis; Drug abuse; Drug usage; Elderly; Enrollment; Epidemic; Epigenetic Process; Fentanyl; Funding; Future; Grant; HIV; HIV Infections; HIV diagnosis; HIV risk; Health; Immune; Incidence; Infection; Inflammation; Injectable; Intervention; Latino; Lead; Location; Longitudinal Studies; Measures; Methods; Midwestern United States; Minority; Modeling; Monitor; Morbidity - disease rate; National Institute of Drug Abuse; Outcome; Output; Participant; Pathogenicity; Pattern; Pharmaceutical Preparations; Phylogenetic Analysis; Physiologic pulse; Physiological; Play; Prevention; Preventive; Process; Publications; Recording of previous events; Research; Research Design; Research Personnel; Resources; Risk; Risk Behaviors; Risk Factors; Sampling; Science; Sentinel Surveillance; Sexual Partners; Specimen; Stress; Training; United States National Institutes of Health; Vacuum; Viral; Work; biobehavior; cardiovascular disorder risk; cohort; comorbidity; cooking; drug of abuse; emerging adult; falls; health disparity; implementation barriers; implementation research; implementation science; improved; innovation; insight; interest; marijuana decriminalization; marijuana legalization; member; men of color; men who have sex with men; minority stress; minority stressor; novel; pre-exposure prophylaxis; protective factors; public health relevance; recruit; repository; response; social stigma; social structure; substance use; success; systemic inflammatory response; transmission process; trend; uptake; young men who have sex with men

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.

在这种竞争的续约中，我们建议继续对有性行为的年轻人进行最大的队列研究 与男人（YMSM）进行过。雷达研究于2014年启动，以提供有关风险的关键见解 以及艾滋病毒和吸毒的受保护因素，并确定促进者和实施的障碍 结束流行病的有效策略。雷达反映了美国艾滋病毒的流行。它专注于年龄 最高的艾滋病毒事件具有少数艾滋病毒差异组的特殊代表（黑色38％，30％ 拉丁裔），位于芝加哥，是艾滋病毒和毒品流行病的城市中心（即库克县是 2017年艾滋病毒事件中的第四名。在最初的赠款期内，我们在招聘方面非常有生产力 （n> 1,200），保留率（> 80％），科学产出（40多个出版物），培训未来学者，并用作 创新研究平台（25多个连接研究；通过NIDA C3PNO联盟的7个概念）。 YMSM占青少年和年轻人中所有新的HIV诊断的近70％ 在美国，所有其他风险群体的事件都在下降，但之间的急剧增加仍在 YMSM颜色。在预防进化和治疗方案的时代，YMSM仍然表现出不足的准备 利用并以高速率下降艾滋病毒护理级联。使用物质和少数压力源 相关的社会，结构和生物学过程是推动分布的关键因素。响应 RFA-DA-20-005我们提出了一项复杂的多层次研究设计，其中我们将增强队列 2020年有300名新的16-20岁新生，并继续关注现有的队列成员。在此续约中，我们将 回答有关YMSM中有关艾滋病毒和药物使用情节的关键新问题。首先（AIM 1），我们将 保持毒品使用，艾滋病毒风险/预防行为的新兴趋势，并继续参与。 我们将绘制YMSM毒品使用的发展轨迹，以成年为重点，重点是如何使用 轨迹和过渡与药物后果有关。此外，注册了多个样本 16-20岁的年轻人（2008，2011，2015，2020）允许我们解散历史（例如，预备冒险；大麻 合法化）和物质使用，艾滋病毒风险和护理的发展变化。接下来（AIM 2），我们将继续 参加队列成员的新认真合作伙伴。我们将通过纵向检查钥匙来扩展先前的工作 二聚体过程在毒品使用问题和艾滋病毒风险行为的发展中所发挥的作用 耦合YMSM之间的传输。第三（AIM 3），我们将基于我们高水平的挑衅性发现 雷达队列中的全身性炎症，无论艾滋病毒状况如何 用来开始预测HIV+和HIV-YMMM的后期病态的物质。最后（AIM 4），雷达将 继续将标本和数据添加到我们特征良好的生物行为存储库中，以提供一个平台 高影响力科学。雷达是潜水员YMMS的独特多级和纵向研究 - 它的延续 将提供关键数据以告知策略以结束艾滋病毒流行。