ABSTRACT
Despite advances in HIV diagnostics, care and prevention strategies, infection rates among adolescent and young adult
sexual and gender minorities (SGM) continue to rise in the United States (US). There is an urgent need to describe the
epidemiology and trajectories of HIV acquisition in this population and to offer age and culturally appropriate scalable
prevention interventions to those at highest risk of infection in the US. This project will engage and retain young SGM in
an innovative longitudinal cohort, enroll them in a dynamic established digital health retention platform (HMP;
HealthMPowerment), monitor HIV risk and prevention behaviors and explore the socioecological factors that influence
the use of new HIV prevention technologies (UG3 phase), while also allowing targeted testing of novel digital health
interventions (UH3 phase). We will also test the efficacy of expanding the core version of HMP (HMP Basic) by adding
adherence tools (HMP Enhanced) for those who are on PrEP or ART to improve adherence and persistence. In Aim 1,
we will enroll and retain a large (n=6000; 3000/year), diverse cohort of sexually active, SGM adolescents and young
adults, ages 13-34, using innovative digital recruitment, engagement and retention strategies. Over the course of the study,
we will longitudinally characterize the sexual behavior, HIV transmission risk, and PrEP uptake trajectories of SGM
youth utilizing epidemiological trajectory analyses to identify the most effective points of intervention (Aim 2). For Aim
3, we will launch a randomized clinical trial to examine the efficacy of HMP Enhanced to improve PrEP adherence
among HIV-negative youth (n ≥750) and ART adherence among HIV-positive youth (n ≥150) compared to HMP Basic.
Finally, we will maximize the productivity of the cohort by testing new and innovative digital health devices, HIV/STI
diagnostics and interventions, informed by the previous aims as well as emerging NIH prevention priorities (Aim 4). Our
investigative team has decades of experience with recruitment, prevention and care of SGM youth and large-scale
longitudinal cohort studies. This study will capitalize upon productive existing partnerships and digital health expertise to
articulate the drivers of the ongoing HIV epidemic among the most vulnerable populations in the US in order to identify
the most effective, expeditious and scalable strategies to address this ongoing public health crisis.
