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，高达 50% 的艾滋病毒感染者 (PWH) 粮食不安全。 更有可能具有较低的抗逆转录病毒治疗依从性、病毒抑制能力降低以及感染发生率增加 越来越多的研究表明，艾滋病毒还会导致心脏代谢的发展。 合并症，但人们对粮食不安全 (FI) 如何影响这些合并症的发展知之甚少 感染者之中。 本研究的目的是更好地了解金融机构如何促进金融机构的发展 调查 PWH 中的心脏代谢合并症，并测试一种新型双语 FI 干预措施，旨在减少 我们将与维克森林大学合作开展这项研究。 传染病专科诊所是瑞安·怀特 (Ryan White) 资助的北卡罗来纳州最大的诊所之一， 每年为包括中南部在内的主要农村地区的 2,000 多名感染者提供服务 阿巴拉契亚地区的 FI 和 HIV 感染率都很高。 在目标 1 中，我们将在患者的日常工作中每年收集最多 3 年的纵向数据 使用这些数据，我们将比较心脏代谢的患病率和发生率。 我们发现，粮食不安全的感染者和不安全的感染者之间的合并症会更多。 与食品安全的感染者相比，更可能患有心脏代谢合并症，包括糖尿病前期和 T2DM 我们还发现，FI 患者的前驱糖尿病和 T2DM 发病率较高。 在目标 2 中，我们将使用随机对照试验设计进行测试。 weCare/Secure，整合同伴导航的双语循证干预的改进版本 和移动医疗，以确定干预措施对粮食不安全的感染者胰岛素敏感性的影响 在目标3中，我们将深入探索半结构化个体的干预效果。 采访。 拟议的研究通过加深我们对“FI 影响 PWH 中“合并症”的发展，并测试“如何采取干预措施来缓解 FI” NIDDK- 相关合并症。”这将是评估 FI 如何导致发展的首批研究之一。 此外，我们将测试一种新型双语干预措施以改善感染者的心脏代谢合并症。 鉴于卫生系统对解决问题的兴趣日益浓厚，通过减少 FI 来提高感染者的胰岛素敏感性。 FI 作为临床实践的常规部分，如果发现干预措施有效，则可以广泛应用 我们的研究团队已在艾滋病毒临床护理机构中传播，并拥有经过验证的记录。 成功地在 PWH 中进行随机试验，已成功使用本报告中提出的方法 申请，并得到进行研究的临床中心的全力支持。