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

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。 在艾滋病毒携带者(PLWHIV)中。 现在艾滋病毒被认为是一种可控的慢性病， 包括心血管疾病在内的并存疾病的识别和治疗日益成为 研究和临床关注。然而，缺少的是护理的另一个关键组成部分 PLWHIV：对创伤病史的综合护理。创伤经历增加感染艾滋病毒的可能性 感染和心血管疾病的风险，但针对PLWHIV的卫生保健很少协调来解决这三个问题 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。PLWHIV中的创伤病史与不一致有关 治疗依从性和不依从性以及创伤病史本身与较差的心血管疾病有关 结果。未能解决创伤问题，严重阻碍了心血管疾病风险策略的采用 在PLWHIV中。 协调和整合艾滋病毒和慢性病等医疗保健的卫生系统 因为心血管疾病可以提供所需的基础设施，以解决这些情况和他们的 治疗。 我们设计了一种新的混合的、文化一致的、循证的护理模式， “治愈我们的心灵和身体”(HMB)，以解决患者的创伤病史和护理障碍，并 让患者做好降低心血管疾病风险的准备。认识到有必要确保艾滋病毒感染者获得CVD 指南-协调护理，我们还确定了实施战略，以准备提供者和诊所 以应对艾滋病毒阳性患者中的心血管疾病风险。因此， 使用第二类混合动力车 有效性/实施研究设计，本研究的目标是增加患者和 组织准备好应对艾滋病患者的创伤和心血管疾病风险。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 艾滋病毒；具体地说，分阶段办法将推动使用旨在教育的执行战略， 监督和支持提供者和工作人员遵守心血管疾病护理指南；(2) 使用 唱着混合的方法，到(A) 评估一段时间以来执行战略的使用情况和效果，以及(B)查明障碍和 组织采用指南的促进者、提供商遵守指南、可行性和 可持续性；以及(3)评估HMB对认知-行为、情绪和身体结果的影响 在260名PLWHIV中，特别是患者积极性、护理参与度、对心血管疾病风险的了解、对 临床医生的建议、心血管健康、精神健康症状和对护理的满意度。W E 将使用RE-AIM框架来指导评估和复制有效计划(REP) 框架，以指导实施战略的使用和在我们的 参与实施设置。

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.