Multilevel strategies to understand and modify the role of structural and environmental factors in HIV outcomes (LITE-2)

Rutgers Biomedical And Health Sciences, Newark NJ

Investigators

Abstract

Populations at elevated risk for HIV in the U.S. continue to experience a high and disproportionate burden, particularly younger groups for whom HIV incidence continues to rise despite advances in HIV prevention. Evidence suggests that differences in individual risk behaviors do not fully explain variations in HIV outcomes and underscore the need to move beyond models of individual-level risk factors to identify and intervene upon the broader contextual factors that shape risk environments. However, much of the research to date is limited in scope and focuses on cross-sectional HIV prevalence, which limits the ability to treat contextual factors as dynamic or to investigate the environments within which risk behaviors occur. We propose to enroll a cohort of approximately 5,500 individuals ages 16 and older in the U.S. who are at higher risk for HIV infection. We will use a combined approach to recruitment that is adaptive to known shifts in digital technology. Participants will complete a survey and home-based sampling for lab-based HIV testing at enrollment and annually thereafter for three years and an ecological momentary assessment (EMA) for six weeks after enrollment. Concordant with study enrollment, we will develop novel metrics to quantify contextual factors (state-level regulatory and social environment indicators) that may influence HIV vulnerability (Aim 1a). We will subsequently utilize the newly developed metrics from Aim 1a along with local contextual factors (local-level HIV prevalence and socioeconomic indicators) and baseline and EMA data to test the hypothesis that broader environmental influences contribute to HIV risk—this hypothesis will specifically test both the impact of contextual factors on daily exposures and the interaction of environmental influences with individual behaviors on undiagnosed HIV infection at baseline (Aim 2). These data will also be used to test a longitudinal model of mechanisms through which state and local contextual factors directly and indirectly influence HIV seroconversion and access to emerging HIV prevention technologies (e.g., emerging PrEP modalities) (Aim 3). Study findings will be systematically reviewed and translated into practical recommendations for Ending the HIV Epidemic–related public health strategies and community-level interventions (Aim 1b). Developing and testing a contextual model of HIV risk has strong potential to improve the next generation of HIV prevention interventions aimed at reducing HIV incidence in the U.S.