Mindfulness and Behavior Change to Reduce Cardiovascular Disease Risk in Older People with HIV

项目总结 在这份K23提案中，我概述了一个全面的五年培训计划，为我的过渡做好准备 提供给独立的R01级研究人员，能够开发新颖、可行且可扩展的集成 行为干预以降低老年人的心理和心血管疾病(CVD)风险 艾滋病毒(OPWH)。为了实现这一目标，我的培训目标是：1.培养专注力和专注力 减少心血管疾病风险的行为改变；获得随机对照试验(RCT)设计和 在OPWH之间实施；以及精通炎症生物标志物研究，以提高我的 了解HIV-CVD的病理生理学。在本申请中，我提出了一个具有重要意义和创新性的 研究战略，一个令人惊叹的跨学科指导团队，以及支持的全面教学计划 这些目标。背景：OPWH不成比例地受到慢性HIV免疫引起的心血管疾病的影响 调节失调和由此引起的炎症。全身性炎症会因心理困扰而加剧。 激活免疫反应，推动促炎性心血管疾病危险行为。有很有希望的证据 建议正念可以是减少心理痛苦和支持的有效干预手段 行为和炎症介导的心血管疾病风险降低。具体目标和研究设计：我建议 从循证方案中提炼和综合正念和行为改变的内容 (基于正念的减压和糖尿病预防计划)开发和试点测试新文本 使用半结构化反馈的消息增强型干预措施，称为“同心同德”(OM-OH) 采访精神困扰的OPWH(N=20)，以及我的多学科指导团队(目标1)。 接下来，我将通过开放式试点(N=5)，通过离职访谈和事后自我报告评估，探索最初的 OM-OH的可接受性，并根据需要进一步提炼OM-OH(目标2)。最后，我将进行一次随机试点 对照试验(RCT；N=50)至a。评估研究方法的可行性和可接受性的基准 与增强的日常护理相比，改进的OM-OH，以及b.)调查对心理健康可能产生的影响 痛苦、炎症和行为性心血管疾病风险(目标3)。调查结果将为R01奠定基础 应用OM-OH降低OPWH患者炎症介导的心血管疾病风险的疗效试验。 培训和指导：我的培训计划将由我的联合小学导师Conall O‘Cleirigh博士和 Gloria Yeh，两位著名的研究人员都专注于艾滋病毒和艾滋病的干预开发和临床试验 分别是心血管疾病。我还将得到一个。)一支由专家共同导师和 合作者，b.)马萨诸塞州综合医院和哈佛医学院丰富的制度环境 学校，以及c.)有针对性的课程作业、科学会议、研讨会和计划出版。与以下内容相关 NHLBI：这款K23符合NHLBI艾滋病毒/艾滋病计划要解决的已公布的研究重点 艾滋病毒相关的心血管合并症。

PROJECT SUMMARY In this K23 proposal, I outline a comprehensive five-year training program that will prepare me for the transition to an independent, R01 level investigator capable of developing novel, feasible, and scalable integrative behavioral interventions to reduce psychological and cardiovascular disease (CVD) risk in older people with HIV (OPWH). To achieve this goal, my training objectives are to: 1.) develop expertise in mindfulness and behavior change for CVD risk reduction; 2.) gain experience in randomized controlled trial (RCT) design and implementation among OPWH; and 3.) develop proficiency in inflammation biomarker research to better my understanding of the HIV-CVD pathophysiology. In this application, I propose a significant and innovative research strategy, an amazing interdisciplinary mentorship team, and comprehensive didactic plan to support these goals. Background: OPWH are disproportionately impacted by CVD attributable to chronic HIV immune dysregulation and resulting inflammation. Systemic inflammation is exacerbated by psychological distress via activating the immune response and driving proinflammatory CVD risk behaviors. There is promising evidence to suggest that mindfulness could be an effective intervention to reduce psychological distress and support behaviorally- and inflammatory-mediated CVD risk reduction. Specific Aims and Research Design: I propose to refine and synthesize mindfulness and behavior change content from evidence-based protocols (mindfulness-based stress reduction and diabetes prevention program) to develop and pilot test a new text message-enhanced intervention called “One Mind One Heart” (OM-OH) using feedback from semi-structured interviews with OPWH in psychological distress (N=20), and my multidisciplinary mentorship team (Aim 1). Next, I will explore, via an open pilot (N=5) with exit interviews and pre-post self-report assessments, the initial acceptability of OM-OH and further refine OM-OH as needed (Aim 2). Finally, I will conduct a pilot randomized controlled trial (RCT; N=50) to a.) evaluate benchmarks of feasibility and acceptability of study methods and refined OM-OH compared to enhanced usual care, and b.) investigate potential for effects on psychological distress, inflammation, and behavioral CVD risk (Aim 3). Findings will provide the foundation for an R01 application to conduct an efficacy trial of OM-OH to reduce inflammatory-mediated CVD risk among OPWH. Training and Mentorship: My training plan will be led by my co-primary mentors Drs. Conall O’Cleirigh and Gloria Yeh, both renowned researchers focused on intervention development and clinical trials for HIV and cardiovascular disease, respectively. I will also be supported by a.) a team of expert co-mentors and collaborators, b.) a rich institutional environment at Massachusetts General Hospital and Harvard Medical School, and c.) targeted coursework, scientific meetings, seminars, and planned publications. Relevance to NHLBI: This K23 is in line with the published research priorities of the NHLBI HIV/AIDS program to address HIV-related cardiovascular comorbidities.