PROJECT SUMMARY Parent Grant: Young people living with HIV (LWH) in the developmental periods ages 16-28 years, which we refer to as “youth and emerging adults” (YEA), have the lowest rates of engagement along the HIV care continuum (HCC), most pronounced for African American/Black and Latinx YEA-LWH. Yet, our knowledge of factors that promote or impede engagement along the HCC is insufficient. The mixed methods prospective longitudinal study focuses on African American/Black and Latinx (AABL) YEA-LWH (ages 16-28 years with HIV in NYC and Newark, NJ, N=270) both with and without viral suppression and uses quantitative, qualitative, biomarker (HIV viral load, drug use), and ecological momentary assessment approaches to uncover, describe, and better understand factors contributing to trajectories of engagement along the HCC over time, with precision, including from YEA-LWH’s perspectives. Proposed Supplement: Rapid ART has become standard policy in HIV treatment on the international, national, and local levels over the last few years. As HIV clinical care sites move to rapid ART implementation, it is important to understand the contextual factors that influence decision making and behavior at this critical juncture along the HCC. While the literature mainly explores the perspectives and experiences of people newly diagnosed adults with HIV, there is a dearth of understanding around YEA-LWH who have been out of care and/or decide to re-engage in care and reinitiate rapid ART. In addition, the U.S. HIV epidemic is characterized by persistent disparities for younger people as well as racial/ethnic, gender, and sexual minorities. It is vital to illuminate the barriers, facilitators, and important contextual factors that influence decisions and behaviors regarding ART re-initiation for AABL sexual and/or gender minority (SGM) YEA-LWH. These critical questions have not yet been explored in the literature. This mixed methods supplement proposal will involve a quantitative analysis of the R01 parent study data examining associations between rapid ART initiation at diagnosis (which is not an aspect of the parent study), demographic and psychosocial factors (substance use, mental health, HIV-related stigma, intersectional stigma, medical distrust, and discrimination), and HIV care engagement. We hypothesize that rapid ART will be associated with HIV care disengagement. For the qualitative portion, we will sample a group of 30 participants recruited from the parent study, half recently re-engaged in care/re-initiating ART and half disengaged/not on ART, to participate in in-depth interviews, Photovoice methodology and focus group discussions to explore the aforementioned psychosocial factors and elicit and describe other emergent contextual factors, driven by a multi-level approach grounded in social action theory. The results from this supplement will contribute to equity-focused recommendations for policy-makers and providers to support AABL SGM YEA-LWH in HIV care re-engagement and rapid ART initiation.

PROJECT NARRATIVE African American/Black and/or Latinx youth and emerging adults living with HIV, who are mostly sexual and gender minorities, experience the highest rates of HIV care disengagement and poor outcomes along the HIV care continuum. Given rapid antiretroviral therapy (ART) – the initiation of ART immediately after diagnosis or upon return to care – is a potential strategy to address gaps in the HIV care continuum in this population, we aim in this study to examine associations between rapid ART, psychosocial factors (e.g. stigma, discrimination, mistrust, mental health and substance use), and HIV care engagement, as well as understand the multilevel barriers and facilitators to HIV care re-engagement and ART re-initiation. We hypothesize that rapid ART will be associated with lower HIV care engagement, and that the aforementioned psychosocial factors will mediate or moderate the association.