FREEDOM-HIV

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Advances in treatment and care have transitioned HIV from a fatal to a chronic disease. Primary health concerns of this population have accordingly transitioned to co-occurring chronic diseases like T2DM and their interaction with HIV treatment. The highest rates of T2DM are found in Deep South states and disproportionately burden Black Americans. Additionally, while only 13% of the U.S. population, Black Americans account for 43% of new HIV diagnoses. Like T2DM, these disparities are most pronounced in the South, where over half of new HIV diagnoses occur. Over half of the racial health disparities related to T2DM and HIV can be attributed to social determinants of health (SDoH), including reduced healthcare access, poverty, transportation barriers, and food insecurity. There is a need for effective and sustainable intervention packages that address T2DM-related outcomes and improve health equity for people living with HIV (PWH). This is critical since people on HIV treatment have poor glycemic outcomes, which can also hinder the HIV treatment adherence. The overall goal of the Food Delivery, Remote Monitoring, and Coaching-Enhanced EDucation for Optimized Diabetes Management for People Living with HIV (FREEDOM-HIV) study is to develop an optimized, multilevel, and scalable intervention to improve T2DM control in low-income Black adults with HIV and T2DM in the Deep South by targeting relevant SDoH. The FREEDOM-HIV study will enroll 80 Black adults with suboptimal SDoH through three health systems in AL and MS. A randomized factorial optimization design using a multiphase optimization strategy (MOST) will evaluate three intervention components: 1) digital health coaching, 2) food box delivery, and 3) remote patient monitoring (RPM). Thus, this project will evaluate multilevel interventions that address changes at the levels of individual (patient), interpersonal (patientcare team communication), organizational (healthcare system-delivered RPM), and community (food box delivery) to improve T2DM management among socially vulnerable Black adults with HIV and T2DM. Aim 1 will identify the combination(s) of the three intervention components that reduce HbA1c (primary outcome) at 12 months. Aim 2 will identify contextual factors that impact implementation of these different interventions using a Consolidated Framework for Implementation (CFIR) approach, and the implementation outcomes will be assessed via the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. This study will leverage multi-healthcare system and healthcare system– industry partnerships from our parent project FREEDOM to develop optimized, sustainable intervention strategies to improve T2DM outcomes in socially vulnerable Black adults living with HIV in the Deep South.