Presentation from the 2015 CFAR Annual Meeting

1. Adolescent & Young Adult
Scientific Working Group
(AYA SWG)
CFAR Annual Meeting
June 12, 2015

2. Objectives
• Review epidemiology of adolescent and young adult (AYA) HIV
• Introduce a working socio-ecologic conceptual framework of HIV infection in AYA
• Present AYA SWG mission and potential initiatives and next steps to move mission
forward
• Highlight funded AYA focused CFAR projects

3. HIV Epidemiology among AYA: Global and U.S.
• Globally:
• 2.1 million adolescents 10-19 living with HIV
• 50% of PLHIV thought to have contracted virus during
adolescence
• ≈ 700,000 youth 15-24 infected in 2013 alone, 250,000 (15-19)
• Less likely to engage/retain in care and less adherent to cART
• HIV-related mortality among adolescents ↑ 50% (2005-2013); ↓ 30%
across other ages
• United States:
• 26% of new HIV-1 infections annually acquired among youth
aged 13-24 years old
• Number of total new HIV diagnoses ↓ by 4% (2000-2006); 
by 21% among youth 13 – 24 year olds.
• Young minority MSM most heavily affected
• Only 1 in 4 infected youth aware of their status
Source: CDC, UNAIDS, WHO

4. HIV Epidemiology among AYA: Baltimore
• 20% of newly infected individuals
between ages of 13-24
• Minority YMSM most heavily
impacted
• Rates increasing (1994-2011) in
Baltimore, while decreasing in other
major cities (San Francisco, Miami,
L.A., NYC)
• ≈60% unaware of their HIV status;
Source: iDEA, Oster et al. AIDS Behav 2013

5. Working Ecologic Framework of AYA
Based on Brofenbrenner's Ecological Framework (Courtesy of Renata Arrington-Sanders)

6. Copyright © 2015 American Medical
Association. All rights reserved.
Wood S, et al. JAMA Pediatr. 2015.

7. AYA SWG History
• January 2015 (interest solicited)
• February 2015 (first meeting)
• Monthly meetings
• Mission statement
• Brainstorming of mechanisms to
achieve goals
• Coming out party (today!)

8. Jacky Jennings, PhD, MPH (SOM/SPH)
structural-level determinants and
interventions, STI and HIV transmission
dynamics, urban, disadvantaged youth​,
Baltimore city
Errol Fields, MD, PhD (SOM)
Peds/Adolescent Medicine
HIV, social networks and risk, venues,
targeted HIV control strategies,
Larissa Jennings, PhD MHS (SPH)
International Health – Social and Behavioral
Interventions
Economic and structural approaches, HIV Prevention,
Mixed Methods
Kate Boehner
CFAR Program
Coordinator
Cui Yang, PhD (SPH)
Health, Behavior, and Society
HIV & substance use risk
reduction, social network
analysis, mobile health,
U.S./International
Tonia Poteat, PhD, MPH, PA-C (SPH)
Epidemiology – Center for Public
Health and Human Rights, LGBT
Health Disparities, HIV prevention and
care, Mixed Methods
Renata Arrington-Sanders, MD, MPH, ScM (SOM/SPH)*
Adult/Peds/Adolescent medicine
Qualitative, structural interventions, U.S..
Julie Denison, PhD, MHA (SPH)*
Behavioral Scientist, HIV
prevention and care, AYA living
with HIV, sub-Saharan Africa,
family-based interventions
Lana Lee, MD (SOM)
Adult/Peds
Adolescent medicine,
Quality improvement,
Systems integration,
Health outcomes,
U.S./International
Allison Agwu, MD, ScM (SOM)*
Adult/Peds Infectious Disease
HIV/AIDS AYA, health disparities &
outcomes, clinical trials, HIV
complications, U.S.
*AYA SWG Co-chairs
Current AYA SWG Members

9. AYA SWG Mission Statement
The mission of the JHU CFAR’s Adolescent and Young Adult SWG is to promote
interdisciplinary research collaborations across the intersecting domains of
adolescent and young adult (AYA) health and HIV.
Our goals are to:
1) Have broad impact in conceptualizing & developing innovative approaches to
address critical scientific gaps for adolescent and young adults aged 13-25 years
old who are living with, affected by, or at risk for HIV in domestic &
international settings
2) Build interdisciplinary bridges across Johns Hopkins institutions to foster
collaborative scholarship & mentorship to junior investigators at JHU
3) Promote translation of research-informed policies & practices impacting AYA
populations by fostering partnerships with policy makers and practitioners

10. CFAR-Funded AYA-related Projects
Julie Denison* - ART adherence as HIV prevention among adolescents living with HIV in Ndola,
Zambia (2012)
Larissa Jennings* - MHealth-Enhanced Economic Empowerment Initiatives for HIV Prevention
among Youth Living in Urban Slums in Kenya (2012)
Errol Fields* - I met him on Jack’D” – Exploring Sex Partner Selection Patterns, HIV Risk Behavior,
and Risk Perceptions of YBMSM using GeoSocial Networking (GSN) Applications in Baltimore City
(2014)
Tonia Poteat* - Reducing HIV Vulnerability among Adolescent and Adult Transgender Women of
Color: A community based assessment of risks and unmet needs (2014)
Michelle Kaufman - Addressing Gender Issues, Violence and HIV on Ethiopian University Campuses:
Elicitation Research and Intervention Development (2014)
*AYA SWG Member

11. MHealth-Enhanced Economic Empowerment Initiatives for HIV
Prevention among Youth Living in Urban Slums in Kenya
Principal Investigator: Larissa Jennings, PhD
• Collaborative Team: Muthoni Mathai, MBChB MMed PhD, Katherine Fritz, PhD MPH, John Ongech,
MBChB, MMed Obs/Gyn, MPH; CFAR Mentor Deanna Kerrigan, PhD
• Study Purpose:
• This study uses mixed methods to characterize local and gendered representations of economic
empowerment, its influence on HIV vulnerability, and the role of mobile technology among Kenyan
youth living in two urban slums
• Background:
• Health-promoting economic empowerment initiatives are under-developed in the global response to
HIV/AIDS. Youth living in impoverished urban settings are particularly vulnerable to HIV given high
risk sexual behaviors, low education, poor access to health services, and reliance on illicit income
generation. African youth have experienced rapid adoption of mobile phone technologies.
• Approach:
• Focus groups (n=20) : Findings will be used to develop an HIV economic empowerment scale
• Quantitative data collection: to evaluate and test the HIV economic empowerment scale

12. “I met him on Jack’d” – Exploring Sex Partner Selection Patterns, HIV Risk
Behavior, & Risk Perceptions of YBMSM using GeoSocial Networking (GSN)
Applications in Baltimore City
Principal Investigator: Errol L. Fields, MD PhD MPH
• Collaborative Team: Jacky Jennings, PhD MPH, Renata Arrington-Sanders, MD MPH, ScM,
Suzanne Grieb, PhD
• Background
• YBMSM (13-24) have had among highest HIV incidence in US and Baltimore
• GSN apps Increasingly reported as sex partner meeting venues by newly diagnosed
YBMSM in Baltimore
• Study Aims
1. To explore utilization patterns of GSN apps for meeting sex partners,
2. To understand the sexual networks affiliated with GSN app venues by exploring
individual and sexual dyad characteristics
3. To explore how participants use apps to assess and mitigate HIV/STI risk with partners
met on GSN apps compared to non-GSN venues
4. To explore perspectives on acceptability and feasibility of using GSN apps to target
YBMSM sex networks for prevention services
• Approach
• YBMSM (18-24) recruited on Jack’d in high viral load venues and areas
• Semi-structured interviews (n=25); focus groups (n=5)

13. Reducing HIV Vulnerability among Adolescent and Adult
Transgender Women of Color: A community based assessment of
risks and unmet needs
Principal Investigator: Tonia Poteat, PhD, PA-C, MPH
• Collaborative Team: Renata Arrington-Sanders, MD, MPH, ScM & Andrea Wirtz, PhD, MHS
• Study Aim:
• To explore, quantify, and develop a response to the burden of HIV among adolescent
and adult transgender women of color (TWOC) in Baltimore
• Background:
• TWOC have higher rates of HIV (rates of overall prevalence as high as 43% in Baltimore)
& among young TWOC (ages 15-24 years) ranges from 19-22%
• Approach:
• Key informant interviews (n=10)
• Focus groups (n=6)
• Quantitative data collection (N=110)

14. Initiatives and Next steps
• Potential initiatives:
• Position paper on adolescents/young adults and HIV, identified gaps*
• Panel discussion/seminar on youth (e.g., ethics, research challenges)*
• Session at the CFAR Social and Behavioral Sciences Research Network Conference (October 2015)*
• Integrate with other CFAR groups (JHU, other CFARs)
• Capitalize on existing databases/networks to address adolescent questions (e.g., MACS, WIHS)
• Increase awareness of adolescents and young adults in existing structures
• Serve as a resource for investigators looking to include adolescents in their research
• Expand (including but not limited to)
• Behavioral economics, micro-financing
• Cost-effectiveness
• Mental health (involve clinical psychologists)
• Health and human Rights
• Ethics
• Housing, correctional facilities, commercial sex work, schools, education, family
• Implementation science
*Initiatives in process

15. THANK YOU!!!!
QUESTIONS? FEEDBACK?
COMMENTS?