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Epidemiologic and clinical information in the United States indicate that HIV transmission and acquisition among adolescents and young adults (youth) remain unchanged, without improvement. Interventions to prevent HIV transmission among youth are critically needed, as are interventions to improve adherence to all components of the continuum of care for youth living with HIV.
The primary mission of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) is to conduct both independent and collaborative research that explores promising behavioral, microbicidal, prophylactic, therapeutic, and vaccine modalities in HIV-infected and at-risk youth aged between 12 and 24.
Through the ATN, the National Institutes of Health is supporting HIV interventional research for youth in the United States.
The ATN comprises 3 cooperative multiproject research programs and a coordinating center. Each program is led by a network hub and has well-defined research themes to assist, guide, and coordinate HIV research project activities.
ATN activities encompass the full spectrum of research needs for youth, from HIV primary prevention for at-risk youth in the community to secondary and tertiary prevention with clinical management of HIV infection among youth living with HIV experiencing adherence challenges.
Epidemiologic and clinical information in the United States indicate that HIV transmission and acquisition among adolescents and young adults (youth) remain unchanged, without improvement. The Centers for Disease Control and Prevention (CDC) estimates that in the United States, youth aged 13 to 24 years accounted for 21% of all new HIV diagnoses in 2016 [
Not only do youth and young adults have the highest rates of undiagnosed HIV [
Through the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN), the National Institutes of Health (NIH) is supporting HIV interventional research for youth in the United States. The primary mission of the ATN is to conduct both independent and collaborative research that explores promising behavioral, microbicidal, prophylactic, therapeutic, and vaccine modalities in HIV-infected and at-risk youth aged between 12 and 24. ATN activities encompass the full spectrum of research needs for youth, from HIV primary prevention for at-risk youth in the community to secondary and tertiary prevention with clinical management of HIV infection among youth living with HIV experiencing adherence challenges. Primary prevention research addresses motivational readiness for and subsequent uptake of biomedical prevention strategies, including innovative, technology-based interventions tailored for youth at greatest risk for HIV infection or transmission. Secondary and tertiary prevention research investigates novel treatment strategies and regimens, antiretroviral therapy (ART) adherence, risk reduction interventions, and linkage to and long-term engagement in care strategies that can lead to optimal ART initiation and sustained virologic suppression. Innovative strategies to engage youth are especially important in vulnerable populations such as youth, who may encounter more obstacles and challenges when attempting to access care [
The ATN is the only domestic, multicenter research network devoted to the health and well-being of HIV-positive and at-risk youth. The NIH initiated the ATN in 2001 after the Adolescent Medicine HIV/AIDS Research Network external scientific advisory panel stated that interventional studies in adolescents were needed. The first, second, and third funding cycles ended in February 2006, 2011, and 2016, respectively; the ATN was re-competed in 2016 and was funded for a fourth, 5-year period. The ATN has demonstrated extensive experience in recruiting and retaining understudied at-risk and HIV-infected youth populations in the United States. During the 10-year period (2003-2013), more than 26,000 youth have been enrolled among 88 ATN studies, with >90% enrollment and retention rates among completed studies. The ATN published descriptive findings of 1712 youth living with HIV/AIDS, recruited from December 2009 to January 2011 from 15 ATN sites to participate in a cross-sectional survey of demographic, psychosocial, and health factors [
In 2016, the ATN was newly structured to better align network resources with scientific priorities and further increase collaborations both within the ATN and with other HIV research networks through 3 adolescent-focused HIV/AIDS clinical trial network hubs (
Adolescent Medicine Trials Network for HIV/AIDS Interventions structure. AC: Analytic Core; CARES: Comprehensive Adolescent Research & Engagement Studies; FSU: Florida State University; iTech: University of North Carolina/Emory Center for Innovative Technology; MC: Management Core; NIH: National Institutes of Health; SRVs: Subject Recruitment Venues; TERA: Triggered Escalating Real-time Adherence; UCLA: University of California Los Angeles; UNC: University of North Carolina.
Led by the
The principal investigators and the programs they lead are summarized in
Overall, the integration of efforts across the programs is overseen by an ATN Executive Committee (EC) through leadership, efficient communication, coordination, and scientific collaboration. The ATN EC also facilitates collaborations with other HIV research networks and investigators, maintaining the overall responsibility for developing, implementing, and adapting the clinical research agenda of the ATN to include the following:
Primary prevention interventions
Biomedical prevention interventions
Novel approaches to identifying undiagnosed infection
Behavioral and social interventions (eg, multilevel, combination prevention, mental health, substance use studies) to address uptake of HIV prevention strategies
HIV continuum of care
Interventions and programs, both independent and collaborative, to improve outcomes
Community- and structural-level interventions to improve outcomes
Strategies to address evolving health care financing challenges
Evaluation of long-acting antiretroviral therapy for treatment
Risk-reduction interventions
Interventions to promote care engagement and adherence to antiretroviral medications
Integrated treatment approaches (psychological, medical, and ancillary services studies).
Furthermore, the EC oversees the coordination and scientific collaboration of the ATN’s National Community Advisory Board, self-titled Youth Experts and Advocates for Health (ATN-YEAH). The ATN-YEAH comprises 12 youth representatives from the programs’ local CABs and provides expertise, consultation, and perspective to ensure that the research agenda and work of the ATN reflects and addresses the current needs and issues of youth. Members also provide feedback on recruitment materials, ATN Network policies, research study protocols and procedures, and potential collaborations. They also serve as liaisons to local ATN-related Community Advisory Boards. Logistically, the members meet via virtual meetings on a quarterly basis and via an annual face-to-face meeting to collaborate on community HIV prevention and care activities, learn from each other’s experiences regarding how HIV affects their lives, and provide input on different research project updates. The annual meeting occurs in conjunction with 1 of the biannual ATN meetings where an ATN-YEAH panel session is highlighted to foster open dialogue between the ATN-YEAH members and ATN research investigators regarding HIV research topics and issues. Youth perspectives and input to the ATN research agenda are further augmented by the direct participation of 3 youth representatives on the EC itself, with voting rights.
The vital importance of stimulating the engagement of junior investigators with fresh perspectives, additional bandwidth, and innovative ideas to the success of the ATN’s research has spurred the ATN to prioritize the mentorship of junior-level investigators through a mentorship/scholars initiative, also monitored by the EC. This initiative includes a comprehensive, research career development program for scholars who come from communities most affected by HIV/AIDS in the United States and who are underrepresented in the scientific field. The program aims to help scholars acquire the skills and expertise to develop and sustain productive, rewarding youth-focused HIV research careers; successfully compete for independent research grants; and develop collaborative working relationships within the context of the ATN’s research efforts.
Adolescent Medicine Trials Network for HIV/AIDS Interventions multiproject research programs.
Adolescent Medicine Trials Network for HIV/AIDS Interventions multiproject research program | Principal investigators | Principal investigator’s institution | Research theme | Number of research projects |
Comprehensive Adolescent Research & Engagement Studies | MJ Rotheram-Borus, PhD | University of California, Los Angeles | Comprehensive, community-based strategies for youth recruitment and engagement | 3 |
iTech | L Hightow-Weidman, MD, MPH, and P Sullivan, PhD, DVM | University of North Carolina, Chapel Hill, and Emory University | Innovative, interdisciplinary, technology-based interventions | 10 |
Scale It Up | S Naar, PhD | Florida State University | Effectiveness-implementation research to enhance youth self-management | 4 |
Adolescent Medicine Trials Network for HIV/AIDS Interventions research projects.
ATNa protocol number | ATN research program | ATN project title |
ATN 138 | iTech | YouThrive: Connecting Youth and Young Adults to Optimize ARTb Adherence Through the Interactive YouTHrive WebApp |
ATN 139 | iTech | Get Connected: Linking YMSMc to Adequate Care through a Multilevel, Tailored WebApp Intervention |
ATN 140 | iTech | LYNX: A Novel Mobile App to Support Linkage to HIV/STId Testing and PrEPe for YMSM |
ATN 141 | iTech | MyChoices: Mobile-Based Application to Increase Uptake of HIV Testing, Detection of New HIV Infections, and Linkage to Care and Prevention Services by Young Men who have Sex with Men |
ATN 142 | iTech | P3: Prepared, Protected, emPowered: Promoting PrEP Adherence through a Social Networking, Gamification, and Adherence Support App for Men and Transgender Women Who Have Sex With Men |
ATN 143 | iTech | Compare: Comparing Efficacy of LYNX (ATN 140) and MyChoices (ATN 141) Mobile Applications for HIV Testing and PrEP Uptake |
ATN 144 | Scale It Up | SMART: Adaptive Antiretroviral Therapy Adherence Interventions for Youth Living with HIV through Text Messaging and Cell Phone Support Embedded within the Sequential Multiple Assignment Randomized Trial (SMART) Design |
ATN 145 | Scale It Up | Young Men’s Health Project: Comparative Effectiveness Trial of Clinic-Based Delivery of an HIV Risk Reduction Intervention for YMSM |
ATN 146 | Scale It Up | TMI: Tailored Motivational Interviewing Implementation Intervention Effectiveness Trial in Multidisciplinary Adolescent HIV Care Settings |
ATN 147 | CARESf | Acute, Recent and Established Youth Living with HIV |
ATN 148 | CARES | Stepped Care for Youth Living with HIV: Optimizing the HIV Treatment Continuum with a Stepped Care Model for Youth Living with HIV |
ATN 149 | CARES | Cost-efficient Interventions for Youth at Risk for HIV: Engaging Seronegative Youth to Optimize the HIV Prevention Continuum |
ATN 150 | ATN Coordinating Center | Consent 2.0: Innovative Approaches for Minor Consent to Biomedical HIV Prevention Research |
ATN 151 | ATN Coordinating Center | Work2Prevent: Employment as HIV prevention for Young Men who have Sex with Men (YMSM) and Young Transgender Women (YTW) |
ATN 152 | ATN Coordinating Center | TERA: A Triggered, Escalating, Real-Time Adherence Intervention |
ATN 155 | ATN Coordinating Center | Planning4PrEP: Integrating PrEP into Family Planning Services at Title X Clinics in the Southeast |
ATN 156 | Scale It Up | WeTest: Enhancing sexual safety: Couples’ communication and HIV testing among YMSM |
ATN 157 | iTech | We Prevent: A Relationships Skills Intervention to Improve HIV Prevention Uptake Among Young Gay, Bisexual and other Men who have Sex with Men and their Primary Partners |
ATN 158 | iTech | Life Steps for PrEP for Youth (LSPY) An Evidence-based Cognitive Behavioral Adherence Intervention to Enhance PrEP Uptake and Adherence in High Risk YMSM |
ATN 159 | iTech | ePrEP: A Randomized, Controlled Trial of an Electronic HIV Pre-exposure Prophylaxis Care System Among Young Men who have Sex with Men in Rural and Small Town Areas |
ATN 160 | iTech | TechStep: Technology‐based Stepped Care to Stem Transgender Adolescent Risk Transmission |
ATN 161 | ATN Coordinating Center | ATN Modeling Core: Investing in the HIV care continuum: Model‐based methods to translate ATN findings into policy recommendations |
aATN: Adolescent Medicine Trials Network for HIV/AIDS Interventions.
bART: antiretroviral therapy.
cYMSM: young men who have sex with men.
dSTI: sexually transmitted infection.
ePrEP: pre-exposure prophylaxis.
fCARES: Comprehensive Adolescent Research & Engagement Studies.
The ATN also encompasses a coordinating center (CC at the University of North Carolina, Chapel Hill, with PIs L LaVange, PhD, M Carpenter, PhD, and M Hudgens, PhD) to provide overall infrastructure and logistical and organizational support for the ATN and to facilitate emerging studies and collaborative activities across the ATN and with external networks and investigators. Support for these newly emerging activities includes statistical, data management, study management, study quality assurance, and operational services and infrastructure. The CC also administratively manages a suite of high-priority research protocols (see
The ATN aims to change the sobering trends among youth affected by HIV in the United States through innovative approaches and a suite of research projects that address many high-priority scientific questions. Overall, the objectives and overarching goals of the ATN are to increase the number of at-risk youth who are aware of their HIV status and bend the infection rate curve downward toward zero, and for those who are diagnosed with HIV, to increase the numbers in each segment of the care continuum to 95%. The ATN with its highly experienced, multidisciplinary investigators has a renewed focus to address the HIV epidemic by addressing both individual and structural issues particularly salient to adolescents. These include stigma, substance use, mental health difficulties, developmental challenges and transitions to adulthood, and availability of and access to youth-friendly health services. Important additional priorities include facilitating mentorship of junior-level investigators as well as including the voices of diverse youth input throughout all activities of the ATN. The ATN remains committed to performing the highest priority research and disseminating findings in a timely and transparent manner with the primary goal of ending the youth HIV epidemic in the United States.
antiretroviral therapy
Adolescent Medicine Trials Network for HIV/AIDS Interventions
coordinating center
Centers for Disease Control and Prevention
Executive Committee
University of North Carolina/Emory Center for Innovative Technology
National Institutes of Health
Pre-Exposure Prophylaxis
Youth Experts and Advocates for Health
young men who have sex with men
The Adolescent Medicine Trials Network for HIV/AIDS Interventions is supported through the National Institutes of Health (U19HD089881, U19HD089875, U19089886, U24HD089880).
The comments and views of the authors do not necessarily represent the views of the
None declared.