Addressing Barriers to the Comprehensive Use of Statins in HIV: The ABACUS-HIV Study

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PROJECT SUMMARY/ABSTRACT The health of persons with HIV (PWH) has improved with the expanded use of effective antiretroviral therapy. Despite these improvements, the risk of atherosclerotic cardiovascular disease (ASCVD) for PWH remains up to twice as high as for those without HIV. PWH bear a high burden of ASCVD risk factors such dyslipidemia and diabetes mellitus, which is increasing as PWH live longer. Statins have proven efficacy to prevent ASCVD. PWH have a greater statin need but lower rates of adequate response to statins than those without HIV, in large part due to nonadherence. There is a need for patient-centered interventions for improving statin adherence that adequately incorporate PWH-specific barriers, such as HIV stigma, low ASCVD risk perception, HIV treatment vs. ASCVD prevention prioritization, and pill fatigue and drug interaction fears from antiretroviral therapy. The objective of this K01 grant is to adapt an intervention promoting statin adherence from the general population to PWH and evaluate the adapted intervention’s acceptability and feasibility in an HIV clinic. We hypothesize that STIC2IT (Study of a Tele-pharmacy Intervention for Chronic diseases to Improve Treatment adherence, “Stick to it”) can be adapted to PWH. STIC2IT is a pharmacist-delivered intervention proven in the general population to improve chronic medication adherence including to statins, via motivational interviewing and tailored resources to reduce adherence barriers. We will analyze existing data from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) and conduct in-depth interviews of PWH in the University of North Carolina Center for AIDS Research HIV Clinical Cohort (UCHCC). We will use interview findings to adapt the intervention and pilot it in the UCHCC. This career development award will provide the PI with training in: 1) qualitative research methods; 2) intervention adaptation and evaluation; and 3) ASCVD prevention and epidemiology. The PI will be closely guided by an interdisciplinary mentoring team of experts in health behavior, epidemiology, cardiology, HIV care, and intervention trials. The Specific Aims are: 1) Among PWH, identify contemporary longitudinal patterns of statin use and effectiveness, and patient groups at greater risk of suboptimal statin use; 2) Systematically adapt the STIC2IT intervention to the needs and preferences of PWH; and 3) Evaluate the acceptability and feasibility of the adapted intervention in an HIV clinic. Carrying out these research aims will reinforce training activities and leverage the PI’s existing skills in HIV, clinical epidemiology, and pharmacoepidemiology studies using large, electronic health records-based clinical cohorts. The study will produce preliminary data for future study planning and a prototype adapted intervention ready to be evaluated for efficacy in R-level grants. This award will support the PI’s career goal of becoming an independent investigator at the forefront of innovative research to improve ASCVD prevention for PWH.