Exploring the consequences of food insecurity and harnessing the power of peer navigation and mHealth to reduce food insecurity and cardiometabolic comorbidities among persons with HIV

探索粮食不安全的后果并利用同行导航和移动医疗的力量来减少艾滋病毒感染者的粮食不安全和心脏代谢合并症

• 批准号: 10461720
• 负责人: Caryn Morse
• 金额: $ 72.34万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-04 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10461720
• 关键词: Address; Adherence; Affect; Age; Anti-Retroviral Agents; Appalachian Region; Area; Cardiometabolic Disease; Caring; Catchment Area; Categories; Clinic; Communicable Diseases; Complement; Data; Development; Diabetes Mellitus; Evidence based intervention; Food; Funding; HIV; Health system; Human immunodeficiency virus test; Incidence; Individual; Insulin Resistance; Intervention; Interview; Longitudinal cohort; Measures; Methods; Modeling; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; North Carolina; Nutritional; Obesity; Participant; Patients; Persons; Prediabetes syndrome; Prevalence; Provider; Randomized; Randomized Controlled Trials; Research; Research Personnel; Risk; Rural; Rural Population; Secure; Structure; Testing; Time; Viral; Visit; Vulnerable Populations; Work; bilingualism; cardiometabolic risk; cardiometabolism; clinical care; clinical practice; clinical research site; comorbidity; ethnic diversity; follow-up; food insecurity; forest; health care service organization; improved; insulin sensitivity; interest; intervention effect; intervention participants; mHealth; medical specialties; mortality; novel; peer; racial and ethnic; randomized trial; social health determinants; success; therapy design; treatment as usual; trial design

Up to 50% of people with HIV (PWH) in the US are food insecure. PWH who are food insecure are more likely to have lower antiretroviral adherence, decreased viral suppression, and increased incidence of serious illness. Increasing research suggests that HIV also leads to the development of cardiometabolic comorbidities, but little is known about how food insecurity (FI) affects the development of these comorbidities among PWH. The objectives of this study are to better understand how FI contributes to the development of cardiometabolic comorbidities among PWH and to test a novel bilingual FI intervention designed to reduce these comorbidities among food insecure PWH. We will conduct this study in partnership with the Wake Forest Infectious Diseases Specialty Clinic, one of the largest Ryan White-funded clinics in North Carolina, which serves more than 2,000 PWH annually from a predominantly rural catchment area that includes South Central Appalachia. This area has high rates of both FI and HIV. In Aim 1, we will collect longitudinal data from each patient yearly for up to 3 years during their routine HIV care visits. Using these data, we will compare the prevalence and incidence of cardiometabolic comorbidities between food secure and insecure PWH. We hypothesize that food insecure PWH will be more likely to have cardiometabolic comorbidities, including prediabetes and T2DM than food secure PWH at baseline. We also hypothesize that those who are FI will have a higher incidence of prediabetes and T2DM than those who are food secure over time. In Aim 2, using a randomized controlled trial design, we will test weCare/Secure, a refined version of a bilingual evidence-based intervention that integrates peer navigation and mHealth, to determine the impact of the intervention on insulin sensitivity among food insecure PWH with prediabetes or T2DM. In Aim 3, we will explore intervention effects though semi-structured individual in-depth interviews. The proposed research complements the RFA’s focus by advancing our understanding of how “FI impacts the development of comorbidities” among PWH and testing “how interventions for FI alleviate NIDDK- relevant comorbidities.” This will be one of the first studies to evaluate how FI leads to the development of cardiometabolic comorbidities among PWH. Additionally, we will test a novel bilingual intervention to improve insulin sensitivity among PWH by reducing FI. Given the growing interest among health systems in addressing FI as a routine part of clinical practice, if the intervention is found to be efficacious, it could be broadly disseminated across HIV clinical care settings. Our team of established investigators has a proven record of success conducting randomized trials among PWH, has successfully used methods proposed in this application, and has the full support of the clinical site where the study will occur.

在美国，多达50％的艾滋病毒（PWH）患者是不安全的。食物不安全的PWH是 更可能具有较低的抗逆转录病毒依从性，降低病毒抑制和增加的发生率 严重疾病。越来越多的研究表明，艾滋病毒也导致心脏代谢的发展 合并症，但对粮食不安全（FI）如何影响这些合并症的发展知之甚少 在PWH中。 这项研究的目标是更好地了解FI如何为发展做出贡献 PWH之间的心脏代谢合并症，并测试旨在减少的新型双语FI干预措施 食品不安全的PWH中的合并症。我们将与Wake Forest合作进行这项研究 传染病专科诊所，北卡罗来纳州最大的瑞安白人捐赠诊所之一，该诊所之一 每年从包括中南部的中南部的乡村集水区中每年提供2,000多个PWH 阿巴拉契亚。该地区的FI和HIV均具有很高的速度。 在AIM 1中，我们将在日常工作中每年收集每位患者的纵向数据，最多3年 艾滋病毒护理访问。使用这些数据，我们将比较心脏代谢的患病率和发病率 食物安全与不安全的PWH之间的合并症。我们假设食品不安全的PWH会更多 与食物安全的PWH相比 基线。我们还假设，那些FI的人将具有较高的糖尿病和T2DM事件 比那些随着时间的流逝而安全的食物。在AIM 2中，使用随机对照试验设计，我们将测试 Wecare/Secure，这是双语循证干预的精致版本，该版本整合了同行导航 和MHealth，以确定干预措施对食物不安全PWH中胰岛素敏感性的影响 糖尿病或T2DM。在AIM 3中，我们将通过深入的个人探索干预效果 访谈。 拟议的研究通过促进了我们对“ FI的理解”来完成RFA的重点 影响PWH之间的合并症的发展”，并测试“ FI的干预措施如何减轻NIDDK- 相关合并症。“这将是评估FI如何导致发展的最早研究之一 PWH中的心脏代谢合并症。此外，我们将测试一种新颖的双语干预措施以改进 通过减少FI，PWH之间的胰岛素灵敏度。鉴于卫生系统对解决 FI是临床实践的常规部分，如果发现干预措施有效，则可以广泛 在艾滋病毒临床护理环境中分发。我们成熟的调查人员团队有一个可靠的记录 在PWH之间进行随机试验的成功已成功地使用了此处提出的方法 应用，并得到了将进行研究的临床部位的全部支持。