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

在美国，高达50%的艾滋病毒感染者（PWH）处于食物不安全状态。食物不安全的威尔斯亲王医院 更可能有较低的抗逆转录病毒依从性，降低病毒抑制，并增加发病率， 严重的疾病。越来越多的研究表明，艾滋病毒也导致心脏代谢性疾病的发展， 共病，但很少有人知道粮食不安全（FI）如何影响这些共病的发展 在PWH。 本研究的目的是为了更好地了解FI如何有助于发展， PWH中的心脏代谢合并症，并测试一种新的双语FI干预，旨在减少 这些并发症在粮食不安全的PWH中。我们将与维克森林合作进行这项研究 传染病专科诊所是北卡罗来纳州最大的瑞安怀特资助的诊所之一， 每年为超过2，000间威尔斯亲王医院提供服务，这些医院主要分布于乡郊地区，包括中南区 阿巴拉契亚。这个地区的FI和HIV感染率都很高。 在目标1中，我们将每年收集每例患者的纵向数据，最长持续3年， 艾滋病毒护理访问。利用这些数据，我们将比较心脏代谢性疾病的患病率和发生率， 粮食安全和不安全的PWH之间的共病性。我们假设，粮食不安全的PWH将更多 可能患有心脏代谢合并症，包括前驱糖尿病和T2 DM，而非食物安全PWH， 基线。我们还假设FI患者的前驱糖尿病和T2 DM发病率较高 比那些食物安全的人更安全。在目标2中，使用随机对照试验设计，我们将测试 weCare/Secure，一个整合了同伴导航的双语循证干预的改进版本 和移动健康，以确定干预措施对食物不安全的PWH中胰岛素敏感性的影响， 糖尿病前期或T2 DM。在目标3中，我们将通过半结构化个体深入探讨干预效果 采访 拟议的研究补充了RFA的重点，推进我们的理解如何“FI 影响PWH和测试之间的共病发展“FI干预如何缓解NIDDK- 相关的合并症”这将是第一个研究，以评估如何FI导致的发展， PWH中的心脏代谢合并症。此外，我们将测试一种新的双语干预，以改善 胰岛素敏感性降低。鉴于卫生系统越来越关注解决 FI作为临床实践的常规部分，如果发现干预有效，则可以广泛使用 在艾滋病毒临床护理环境中传播。我们的调查员团队有着良好的记录， 成功地进行随机试验之间的PWH，已成功地使用的方法提出了这一点 申请，并得到研究所在临床研究中心的全力支持。

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.