The ATN is the only national, multicenter research network devoted to the health and well-being of HIV-infected and at-risk adolescents and young adults. The Network was started by the Maternal and Pediatric Infectious Disease Branch (MPIDB) (formerly the Pediatric, Adolescent, and Maternal AIDS Branch) in 2001 through a cooperative agreement mechanism with co-funding from the National Institute on Drug Abuse and the National Institute of Mental Health. The ATN was created following the recommendation of the Adolescent Medicine HIV/AIDS Research Network external scientific advisory panel that a need existed for interventional studies in adolescents. The first and second funding cycles ended in February 2006 and 2011, respectively; the ATN was re-competed in 2010 and was funded in 2011 for a third five-year period.
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 HIV at-risk adolescents, ages 12 years through 24 years. ATN activities encompass the full spectrum of research needs for youth: from primary prevention, including HIV preventive vaccine, microbicide and pre-exposure prophylaxis (PrEP) trials, for HIV at-risk youth in the community, to clinical management of HIV-infected youth, including novel treatment strategies and regimens, drug adherence, risk reduction, and linkage and engagement to care.
The ATN includes a range of studies that include: primary prevention in uninfected youth, including preparation for HIV-preventive vaccine trials, PrEP and microbicide studies; and clinical management of HIV-infected youth, including treatment regimens and management strategies, medication adherence, risk reduction, and linkage and engagement to care.
The overall research agenda of the ATN includes three broad areas:
- Therapeutics—The therapeutic agenda of the ATN seeks to improve understanding of HIV immunopathogenesis, optimize diagnosis and management, and to improve HIV-related co-morbidities in HIV-infected youth.
- Behavior—The behavioral research agenda of the ATN is broadly defined to include the development, adaptation, implementation, and/or evaluation of culturally appropriate, theory-driven behavioral preventive interventions for HIV and other sexually transmitted diseases in at-risk youth. In addition to prevention studies, the behavioral research agenda aims to examine interventions that preserve and improve the well-being of HIV-infected adolescents and young people.
- Community Prevention—Community consultations conducted at the beginning of the ATN revealed that the responsibility for decision making on an HIV research agenda for youth should rest with the communities themselves. To address this issue, studies within the ATN include community prevention protocols, such as Connect-to-Protect® (C2P). The C2P program aims to build community trust and engagement, establish a primary prevention research infrastructure, and test a model of community mobilization that uses structural change to produce measurable improved-health outcomes in community youth. These types of protocols are critical to creating lasting behavior change with the ultimate hope of reducing risk for HIV acquisition among youth. Secondary prevention is
another burgeoning area of urgent need to address the youth HIV epidemic and
part of the ATN's commitment to improving individual treatment outcomes among
infected youth along the entire continuum of care through protocols to enhance
the identification and linkage to care of those who were previously unaware
they were infected. Studies would also address youth retention in care, the prompt
initiation of antiretroviral therapy, and barriers to adherence, which would
lead to durable virologic suppression and would reduce secondary transmission
Adolescent Medicine Trials Units
There are currently 14 NICHD-funded clinical research sites within the ATN where interested youth can join clinical protocols:
- Baylor College of Medicine
- Children's Hospital of Los Angeles
- Children's Hospital of Philadelphia
- Children's National Medical Center (Washington, DC)
- Cook County Hospital (Chicago, IL)
- Fenway Community Health Center (Boston, MA)
- Johns Hopkins University
- Montefiore Medical Center (Bronx, NY)
- St. Jude Children's Research Hospital
- Tulane University Medical Center
- University of Colorado, Denver
- University of Miami
- University of South Florida
- Wayne State University
ATN Leadership and Operations
The NICHD funds two large awards that are responsible for the creation of the ATN's scientific agenda, and for management of the data and operational aspects of the research conducted in the network:
- The ATN Coordinating Center (ACC) provides the necessary scientific leadership and infrastructure support for the ATN. The ACC Principal Investigator assembles the necessary multidisciplinary team of established investigators from across the United States, to set the research agenda for the network, and outlines the priority areas, plans, processes, and timelines for achieving the implementation of the proposed agenda.
- The ATN Data and Operations Center (DOC) is responsible for providing the ATN's infrastructure and organizational support. This includes the funding of study needs and subject enrollment to protocols at the clinical sites, staff and site training, and quality assurance procedures, including site monitoring. The DOC also provides support for ATN study development and conduct, management of the study databases, analytic capacity, and regulatory adherence.