Abstract
Youth represent 21% of new HIV diagnoses in the United States. Gay, bisexual, and transgender (GBT) youth, particularly those from communities of color, and youth who are homeless, incarcerated, in institutional settings, or engaging in transactional sex are most greatly impacted. Compared with adults, youth have lower levels of HIV serostatus awareness, uptake of antiretroviral therapy (ART), and adherence. Widespread availability of ART has revolutionized prevention and treatment for both youth at high risk for HIV acquisition and youth living with HIV, increasing the need to integrate behavioral interventions with biomedical strategies. The investigators of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) completed a research prioritization process in 2019, focusing on research gaps to be addressed to effectively control HIV spread among American youth. The investigators prioritized research in the following areas: (1) innovative interventions for youth to increase screening, uptake, engagement, and retention in HIV prevention (eg, pre-exposure prophylaxis) and treatment services; (2) structural changes in health systems to facilitate routine delivery of HIV services; (3) biomedical strategies to increase ART impact, prevent HIV transmission, and cure HIV; (4) mobile technologies to reduce implementation costs and increase acceptability of HIV interventions; and (5) data-informed policies to reduce HIV-related disparities and increase support and services for GBT youth and youth living with HIV. ATN’s research priorities provide a roadmap for addressing the HIV epidemic among youth. To reach this goal, researchers, policy makers, and health care providers must work together to develop, test, and disseminate novel biobehavioral interventions for youth.
Highlights
The HIV Epidemic in the United StatesHIV infections among adolescents and young adults aged 13 to 24 years have more than doubled in the last 15 years, and these individuals represented 21% of the epidemic population in the United States in 2018 [1,2,3]
Given that more than 96% of youth aged 18 to 29 years in the United States have smartphones and regularly use the internet for a variety of activities, interventions delivered through the internet and mobile phones are highly acceptable to youth [103,104]
The Modeling Core is using a novel approach to microsimulation modeling of HIV disease progression, patterns of care, and treatment outcomes, and applying innovative statistical methods to populate the model with data about patterns of health care, HIV viral load trajectories, and antiretroviral therapy (ART) derived from completed AIDS Interventions (ATN) studies and other national studies
Summary
HIV infections among adolescents and young adults aged 13 to 24 years have more than doubled in the last 15 years, and these individuals represented 21% of the epidemic population (approximately 7100 infected youth) in the United States in 2018 [1,2,3]. The CARES approach focuses on messages and probes, which address the following core functions of behavioral change: establish a framework for change, convey necessary information, build self-management skills, address barriers, and provide tools and support Scale It Up is conducting an effectiveness trial, called SMART, of an intervention comparing text messaging and cell phone support to improve HIV medication adherence among youth living with HIV. The Modeling Core is using a novel approach to microsimulation modeling of HIV disease progression, patterns of care, and treatment outcomes, and applying innovative statistical methods to populate the model with data about patterns of health care, HIV viral load trajectories, and ART derived from completed ATN studies and other national studies This model will be used to evaluate the potential clinical and economic impacts of ATN intervention trials to support medication adherence, retention in care, and improved clinical outcomes for youth living with HIV and inform decision makers [114,115]. The ATN will continue to regularly review its priorities and launch new studies in response to changing needs, scientific advances, and epidemiological shifts in HIV incidence
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