Linkages between HIV/STI prevention and syndemic behaviors in high risk youth: Common factors and unique pathways

ABSTRACT Current data continue to reflect that the likelihood of being infected with HIV is elevated among certain groups who have historically been less well represented in research, including youth ages 13-24, young people of color (POC), and sexual and gender minority (SGM) youth. During the past 13 years, our team has completed 6 sizable HIV/STI behavioral prevention intervention studies with youth: 3 large-scale NIH-funded randomized controlled trials (RCTs) and 3 smaller single-arm projects targeting reducing HIV/STI and syndemic health risk behavior, generating a collective total of N=1,136 independent youth who were successfully enrolled in and delivered HIV/STI and/or syndemic health risk prevention programming (>91% fully completing interventions) and followed at 1-, 3-, 6-, and/or 12-months post intervention delivery (overall retention rates of >92% across waves). When examined individually, each study revealed that youth significantly improved post-intervention, but effect sizes were small. Yet, even among disparate intervention modalities delivered with high fidelity – such as those targeting introspective examination of the capacity for change (motivational interviewing; MI), education-based approaches, reward-based interventions (behavioral skills training; BST), and mindfulness- based approaches, the differences between intervention types have been minimal. One consistent theme relevant to youth intervention outcome emerged: the role of common factors, and specifically, youth:provider relationship. For this proposal, we engage experts in clinical (MPI Feldstein Ewing) and quantitative (Co-I Bryan) evaluations of HIV/STI and syndemic risk reduction with youth, advanced longitudinal models of youth alcohol and cannabis use and their intersection with HIV/STI risk (MPI: Chung), and longitudinal mixed-effects machine learning and patient-provider relationships (Co-I Yang, Consultant Choudhary). Together, we aim to collaboratively harmonize our 6 sizable HIV/STI and syndemic behavioral intervention studies to interrogate these data using cutting-edge analytic methods and robust machine learning model testing. This innovative approach will unearth crucial relations in youth HIV/STI and syndemic intervention response, in a diverse sample of youth at very high risk for HIV (M = 17 years of age, range 13-24 at baseline; 43% female; 21% SGM; 54% Hispanic; 9% African American; 7% Native American/Alaska Native). These data are crucial to informing next step HIV/STI and syndemic intervention programming, as they will illuminate what works (and does not) in this age group. In terms of study goals, this R01 will use an atheoretical data-driven approach to harness youth prevention intervention data to drive a developmentally- specific model of youth HIV/STI and syndemic prevention intervention response. Via machine learning, we will investigate associations between youth:provider relationship and intervention outcomes (primary outcome: HIV/STI risk behaviors) among adolescents engaged in HIV/STI risk behaviors.