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: 10403810
• 负责人: Brian Mustanski
• 金额: $ 8.29万
• 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/10403810
• 关键词: 20 year old; Adolescent and Young Adult; Adult; Affect; Age; Applications Grants; Automobile Driving; Behavior; Biological Markers; Biological Process; Birth; Caring; Cause of Death; Chicago; Cohort Studies; Color; Continuity of Patient Care; County; Coupled; Data; Depressed mood; Development; Diagnosis; Drug abuse; Drug usage; Elderly; Enrollment; Epidemic; Event; Faculty; Feeling suicidal; Female; Foundations; Future; Goals; Grant; HIV; HIV Infections; HIV diagnosis; HIV risk; Health; Impairment; Incidence; Individual; Interdisciplinary Study; Interleukin-1 beta; Interleukin-10; Interleukin-15; Interleukin-6; Intervention; Joints; Knowledge; Latino; Light; Link; Longitudinal Studies; Mediating; Mediator of activation protein; Mental Depression; Mentors; Mentorship; Methodology; Methods; Minority; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Outcome; Output; Overdose; Pathogenicity; Pathway interactions; Pharmaceutical Preparations; Physiologic pulse; Play; Population; Prevention; Preventive; Process; Prospective Studies; Public Health; Publications; Research; Research Design; Resources; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Science; Sexual Partners; Sexual and Gender Minorities; Specimen; Stress; Subgroup; Suicide; Suicide attempt; System; TNF gene; Testing; Time; Time trend; Training; Victimization; Work; Youth; biobehavior; cisgender; cohort; cooking; coping; design; emotion regulation; experience; falls; gender minority; health disparity; heuristics; high risk; indexing; innovation; insight; interest; male; marijuana legalization; member; microaggression; mortality; novel; perceived stress; pre-exposure prophylaxis; prescription drug abuse; programs; protective factors; public health relevance; recruit; repository; research study; response; risk sharing; sexual minority; skills; social stigma; social structure; stressor; substance use; systemic inflammatory response; transgender; transmission process; trend; 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.

在这次竞争更新中，我们建议继续对发生性行为的年轻男性进行最大规模的队列研究 RADAR 研究于 2014 年启动，旨在提供有关风险的重要见解。 艾滋病毒和吸毒的影响和保护因素，并确定实施该计划的促进因素和障碍 结束这一流行病的有效策略反映了美国艾滋病毒流行情况； 艾滋病毒发病率最高，少数族裔艾滋病毒差异群体具有特殊代表性（38% 是黑人，30% 拉丁裔），位于艾滋病毒和毒品流行的城市中心芝加哥（即库克县 2017 年艾滋病毒发病率排名第四）。在我们最初的资助期间，我们的招聘工作非常高效。 (N>1,200)、保留率 (>80%)、科学产出（40 多篇出版物）、培训未来的学者并充当 创新研究平台（25 多项关联研究；来自 NIDA C3PNO 联盟的 7 个概念）。 YMSM 占青少年和年轻人所有新 HIV 诊断的近 70% 在美国，虽然所有其他风险群体的发病率均呈下降趋势，但 YMSM 的色彩 在预防和治疗选择不断发展的时代，YMSM 仍然表现出不足的 PrEP。 药物使用率和少数族裔压力源的使用率和艾滋病毒护理级联的下降率很高。 相关的社会、结构和生物过程是造成差异的关键因素。 RFA-DA-20-005 我们提出了一个复杂的多层次研究设计，我们将在其中增强队列 2020 年，我们将招募 300 名新的 16-20 岁成员，并继续关注现有的队列成员。 首先，我们将回答有关 YMSM 中艾滋病毒和药物滥用流行病的关键新问题（目标 1）。 密切关注药物使用、艾滋病毒风险/预防行为和护理持续参与方面的新趋势。 我们将绘制成年期吸毒的 YMSM 发展轨迹，重点关注如何吸毒 此外，轨迹和转变与药物后果相关。 16-20 岁的人（2008 年、2011 年、2015 年、2020 年）使我们能够理清历史（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 我们将通过纵向检查关键点来扩展我们之前的工作。 二元过程在物质使用问题和艾滋病毒危险行为的发展中所发挥的作用，以及 第三（目标 3），我们将建立在高水平的挑衅性发现的基础上。 通过收集 RADAR 队列中的致病性生物标志物，无论 HIV 状态如何，系统性炎症 最后（目标 4），RADAR 将开始预测 HIV+ 和 HIV-YMSM 的晚年发病情况。 继续将样本和数据添加到我们特征明确的生物行为存储库中，为 RADAR 是对不同 YMSM 的独特多层次纵向研究——它的延续。 将提供关键数据，为结束艾滋病毒流行的战略提供信息。