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

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Project Summary During this unprecedented time of social distancing, investigators and health systems must understand the challenges faced by vulnerable patients and research participants and develop new strategies, including telehealth, to provide continuity of research engagement and care delivery that reduce risks for immunocompromised individuals, including people living with HIV (PLWH). The “Enhancing patient and organizational readiness for cardiovascular risk reduction among ethnic minority patients living with HIV” parent grant provides the Healing our Hearts, Minds, and Bodies (HHMB) intervention to Black and Latinx PLWH who have both trauma histories and cardiovascular risks. The goal of the trial is to increase patient and organizational readiness to address trauma and CVD risk among 260 Black and Latinx PLWH recruited from two HIV clinics in Southern California. For these vulnerable patients, it is incumbent upon our team to continue delivering the intervention while generating new knowledge in the context of the coronavirus (COVID-19) pandemic. The unpredictable onset and course of COVID-19, and the health and environmental effects that it presents for our vulnerable participants, have uncovered many important challenges in conducting health behavior research in high-risk, hard-to-reach populations. Current HHMB participants and those recruited for future HHMB groups now face additional environmental exposure risks that can interact with their HIV status and CVD risks, increasing negative health consequences, with severe ramifications that include death. Therefore, it is critical to provide culturally relevant programming that will encourage sustained engagement and maximize retention in research designed to reduce health risks as well as facilitate care. Retention efforts are likely to prevent and control chronic disease, and reduce morbidity and premature mortality, leading to improved overall health and wellness. In an effort to follow current safer-at-home mandates, mitigate environmental exposures, and provide continued health promotion, social support, and interaction during these uncertain times, we propose to convert our intervention to a virtual platform. This conversion will enable participants to receive services that are timely during COVID-19 and promote health on factors specific to the parent grant (i.e., cardiovascular health, HIV, and trauma). We propose two supplemental aims that will be achieved in an integrated mixed methods design: (1) to evaluate the impact of virtual delivery of the HHMB intervention on clinical outcomes (e.g., Life’s Simple 7, depression, anxiety, post-traumatic stress); and (2) to evaluate the evolving impact of COVID-19 on HHMB participants’: a) physical, mental, and emotional well- being and self-care for HIV, CVD risk factors, and other chronic conditions; b) daily lives, including their access to health care, needed social services, and other community resources; and c) engagement in and satisfaction with the delivery format (in person vs. virtual) of the HHMB intervention.