Enhancing patient and organizational readiness for cardiovascular risk reduction among ethnic minority patients living with HIV

加强患者和组织为降低少数族裔艾滋病毒感染者的心血管风险做好准备

• 批准号: 10171414
• 负责人: ARLEEN F. BROWN
• 金额: $ 72.89万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10171414
• 关键词: Acquired Immunodeficiency Syndrome; Acute myocardial infarction; Address; Adherence; Adoption; Adult; Affect; African American; Antihypertensive Agents; Aspirin; Attention; Behavioral; Cardiac Catheterization Procedures; Cardiovascular Diagnostic Techniques; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Client; Clinic; Clinical; Cognitive; Complex; Coronary Angiography; Coronary Artery Bypass; Diabetes Mellitus; Disease Outcome; Effectiveness of Interventions; Emotional; Ensure; Evaluation; Failure; General Population; Goals; Guidelines; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; Health system; Healthcare; Hybrids; Hypertension; Infrastructure; Knowledge; Latino; Left; Lipids; Medical; Mental Health; Methods; Mind; Mind-Body Intervention; Modeling; Monitor; Morbidity - disease rate; Myocardial Infarction; Outcome; Patients; Persons; Phase; Prevention; Procedures; Program Reviews; Provider; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Recording of previous events; Replicating Effective Programs; Research; Research Design; Risk Factors; Risk Reduction; Services; Symptoms; Time; Trauma; Trauma patient; United States; Use Effectiveness; Vulnerable Populations; Woman; antiretroviral therapy; barrier to care; base; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; care coordination; comorbidity; design; effectiveness implementation study; ethnic minority population; experience; healing; high risk; implementation framework; implementation strategy; men; mortality; novel; organizational readiness; programs; provider adherence; public health relevance; satisfaction; service organization; standard care; systematic review; treatment adherence

Abstract/Project Summary Cardiovascular disease (CVD) has emerged as an increasingly important cause of morbidity and mortality among people living with HIV (PLWHIV). Now that HIV is considered a manageable chronic disease, the identification and treatment of comorbid medical conditions including CVD are increasingly the focus of research and clinical attention. What is missing, however, is yet another critical component of care for PLWHIV: integrated care for histories of trauma. Experiences of trauma increase the likelihood of HIV infection as well as CVD risk, yet health care for PLWHIV is rarely coordinated to address these three intersecting issues of HIV, CVD, and trauma, particularly among those disproportionately affected by HIV, i.e., ethnic minority patients. Histories of trauma among PLWHIV are associated with inconsistent treatment adherence and non-adherence, and trauma history alone is associated with poor CVD outcomes. Failure to address trauma poses significant barriers to the adoption of CVD risk strategies among PLWHIV. Health systems that coordinate and integrate care across HIV and chronic conditions such as CVD may provide the infrastructure needed to address the complex interplay of these conditions and their therapies. We have designed a novel blended, culturally-congruent, evidence-informed care model, “Healing our Minds and Bodies” (HMB), to address patients' trauma histories and barriers to care, and to prepare patients to engage in CVD risk reduction. Recognizing the need to ensure that PLWHIV receive CVD guideline-concordant care, we have also identified implementation strategies to prepare providers and clinics for addressing CVD risk among their HIV-positive patients. Therefore, using a hybrid type II effectiveness/implementation study design, the goal of this study is to increase both patient and organizational readiness to address trauma and CVD risk among PLWHIV. The Specific Aims are: (1) to assess and enhance organizational readiness for addressing trauma and CVD risk among ethnic minority PLWHIV; specifically, a phased approach will drive the use of implementation strategies designed to educate, monitor, and support providers and staff in adhering to CVD care guidelines; (2) u sing mixed methods, to (a) evaluate the use and effectiveness of implementation strategies over time, and (b) identify barriers and facilitators to organizational adoption of guidelines, provider adherence to guidelines, feasibility, and sustainability; and (3) to evaluate the effect of HMB on cognitive-behavioral, emotional, and physical outcomes among 260 PLWHIV, specifically patient activation, engagement in care, knowledge of CVD risk, adherence to clinicians' recommendations, cardiovascular health, mental health symptoms, and satisfaction with care. W e will use the RE-AIM framework to guide the evaluation and the Replicating Effective Programs (REP) Framework to guide the use of implementation strategies and the tailoring of the care model within our participating implementation settings.

摘要/项目摘要 心血管疾病（CVD）已成为发病率和死亡率日益重要的原因 艾滋病毒感染者（PLWHIV）。 现在艾滋病毒被认为是一种可控制的慢性疾病 包括CVD在内的合并症的识别和治疗越来越受到人们的关注 然而，缺少的是研究和临床关注。 艾滋病毒携带者：对创伤史的综合护理会增加感染艾滋病毒的可能性。 感染以及 CVD 风险，但很少协调 PLWHIV 的医疗保健来解决这三个问题 艾滋病毒、心血管疾病和创伤的交叉问题，特别是在那些受艾滋病毒影响不成比例的人中， 即，少数民族患者的创伤史与艾滋病毒携带者的不一致有关。 治疗依从性和不依从性以及创伤史与不良心血管疾病相关 未能解决创伤问题对采用 CVD 风险策略构成重大障碍。 艾滋病毒感染者中。 卫生系统协调和整合艾滋病毒和慢性病的护理，例如 因为 CVD 可以提供解决这些条件及其复杂相互作用所需的基础设施 疗法。 我们设计了一种新颖的混合式、文化一致性、循证护理模式， “治愈我们的思想和身体”(HMB)，旨在解决患者的创伤史和护理障碍，并 认识到需要确保 PLWHIV 接受 CVD 治疗，让患者做好参与降低 CVD 风险的准备。 指南一致的护理，我们还确定了实施策略，以帮助提供者和诊所做好准备 解决 HIV 阳性患者的 CVD 风险。 使用混合型 II 有效性/实施研究设计，本研究的目标是增加患者和 组织准备好应对 PLWHIV 中的创伤和 CVD 风险，具体目标是：(1) 评估和加强组织应对少数民族创伤和心血管疾病风险的准备情况 具体来说，分阶段的方法将推动旨在教育、 监督并支持提供者和工作人员遵守 CVD 护理指南 (2) 你 唱混合方法，到（a） 随着时间的推移，评估实施战略的使用和有效性，以及 (b) 识别障碍和 促进组织采用指南、提供者遵守指南、可行性和 可持续性；(3) 评估 HMB 对认知行为、情绪和身体结果的影响 在 260 名 PLWHIV 感染者中，特别是患者的积极性、参与护理、CVD 风险知识、遵守 瓦 e 将使用RE-AIM框架来指导评估和复制有效计划（REP） 指导战略实施和护理模式定制的框架 参与实施设置。