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 艾滋病病毒感染者（PLWHIV）。 既然艾滋病毒被认为是一种可控制的慢性疾病， 包括CVD在内的共病医学状况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：创伤史的综合护理。创伤的经历增加了感染艾滋病毒的可能性 感染以及心血管疾病风险，但艾滋病毒感染者的卫生保健很少协调，以解决这三个问题， 艾滋病毒、心血管疾病和创伤的交叉问题，特别是在受艾滋病毒影响不成比例的人群中， 也就是说，少数民族患者。艾滋病毒感染者的创伤史与不一致的 治疗依从性和不依从性以及创伤史与CVD不良相关 成果。未能解决创伤对采用CVD风险策略构成重大障碍 艾滋病毒携带者之间的关系。 协调和整合艾滋病毒和慢性病护理的卫生系统， 由于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， 治疗 我们设计了一种新颖的混合，文化一致，循证护理模式， “治愈我们的身心”（HMB），以解决患者的创伤史和护理障碍， 帮助患者降低CVD风险。认识到需要确保艾滋病毒/艾滋病感染者接受心血管疾病治疗 我们还确定了实施战略，使提供者和诊所做好准备， 来解决HIV阳性患者的心血管疾病风险。因此，我们认为， 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 在组织上做好准备，以应对艾滋病毒感染者中的创伤和心血管疾病风险。具体目标是：（1） 评估和加强组织准备，以应对少数民族的创伤和心血管疾病风险 艾滋病毒感染者;具体而言，分阶段的方法将推动使用旨在教育， 监测，并支持供应商和工作人员遵守CVD护理指南;（2） u 唱混合的方法，以（a） 随着时间的推移评估实施策略的使用和有效性，以及（B）识别障碍并 组织采用指南的促进者，提供者遵守指南的情况，可行性，以及 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，特别是患者激活，参与护理，了解CVD风险，坚持 临床医生的建议，心血管健康，心理健康症状和护理满意度。W e 将使用RE-AIM框架来指导评估和复制有效计划（REP） 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.