Enhanced Cohort methods for HIV Research and Epidemiology (ENCORE) in the United States

Johns Hopkins University, Baltimore MD

Investigators

Linked publications & trials

Abstract

In the United States, women are prioritized in the US national strategy to end the epidemic. Multiple individual, interpersonal, and structural vulnerabilities fuel the HIV epidemic among women, and worsen health conditions (e.g., substance use and mental health disorders). National cohorts are critical to monitoring epidemic trends and how major events (e.g., epidemics, new biomedical interventions) impact HIV and other health conditions. The objective of this proposal is to use a novel, hybrid “community hub”-supported digital cohort (“hub-supported digital cohort”) model to evaluate HIV incidence, risk factors, and health conditions among women in the US (N=3,000). In this model, on-the-ground community “hubs” will support enrollment and retention of a nationwide digital cohort. We will refine optimal digital cohort methods while examining the impact of structural and psychosocial syndemic experiences on HIV incidence and parameterizing mathematical models to identify targets for future multi-level combination HIV prevention interventions. The specific aims are: 1) Determine the efficiency and acceptability of using a novel, hub-supported digital cohort model to enroll and retain a sample of women for HIV research. 2) Estimate the prevalence and characterize patterns of co-occurring health conditions among women. 3) Estimate HIV incidence in women, followed every 6 months for at least 24 months to identify tailored approaches for combination, multi-disciplinary HIV prevention interventions. 3.1) Examine the effect of co-occurring health conditions on HIV incidence among women in the US. 3.2) Characterize the PrEP continuum among women and associations with HIV incidence over time, including uptake of newly emerging formulations, longitudinal patterns of HIV risk and adherence, and the role of co-occurring health conditions in the PrEP continuum PrEP uptake, adherence, and retention. 4.) Develop dynamic models of multi-level combination HIV prevention interventions and scale-up among women to simulate the impact of evaluated interventions on HIV incidence through 2030, corresponding to the National HIV strategy. There is a need to refine and evaluate hybrid digital cohort models with attention to mitigating selection bias and attrition of different populations – an important area of research. Our explicit efforts to develop a hybrid cohort model center on a focus to support research participation across different populations and provide representative and generalizable data. Study findings will provide critical epidemiologic parameters for future HIV prevention research, provide a platform for exploration of other research questions, and inform the development of evidence-based and acceptable HIV interventions to reduce HIV acquisition among women in the US. Public Health Statement Women are highly burdened by the HIV epidemic in the United States. This proposal will use a novel, technology-infused “community hub”-supported digital cohort (“hub-supported digital cohort”) model to evaluate HIV incidence, co-occurring health conditions, and risk factors among women in the US and Puerto Rico. We will refine optimal digital cohort methods, gather 24 months of longitudinal data from women, examine individual and contextual predictors of HIV incidence, and utilize cohort and contextual data to parameterize mathematical models for the identification of effective HIV prevention interventions to change the trajectory of HIV and co-occurring health conditions among women in the US.