Enhancing patient and organizational readiness for cardiovascular risk reduction among ethnic minority patients living with HIV

项目摘要 在这个前所未有的社会疏远时期，调查人员和卫生系统必须理解 弱势患者和研究参与者面临的挑战，并制定新的战略，包括 远程医疗，以提供研究参与和护理交付的连续性，从而降低 免疫受损个人，包括艾滋病毒携带者(PLWH)。“增强病人的耐心和 少数民族HIV“父母”患者降低心血管风险的组织准备情况 格兰特为黑人和拉丁裔PLWH提供治愈我们的心脏、精神和身体(HHMB)干预 既有创伤史又有心血管风险。试验的目标是增加患者的耐心和 在260名黑人和拉丁裔PLWH中，组织准备好应对创伤和心血管风险 南加州的两家艾滋病诊所。对于这些脆弱的患者，我们的团队有责任继续 提供干预措施，同时在冠状病毒背景下产生新知识(新冠肺炎) 大流行。新冠肺炎的不可预测的发病和病程，以及健康和环境电子ff表明 为我们脆弱的参与者提供的礼物，揭示了在开展健康方面的许多重要挑战 对高危、难以接触人群的行为研究。目前的HHMB参与者和为 未来的HHMB群体现在面临着额外的环境暴露风险，这可能会与他们的艾滋病毒状况相互作用 以及心血管疾病风险，增加了对健康的负面影响，严重的fi阳离子包括死亡。 因此，至关重要的是提供与文化相关的节目，鼓励持续参与。 并最大限度地保留旨在降低健康风险和促进护理的研究。留住努力 有可能预防和控制慢性病，减少发病率和过早死亡，导致 改善整体健康和健康状况。在遵循当前更安全的居家要求的eff中， 环境暴露，并在此期间提供持续的健康促进、社会支持和互动 在不确定时期，我们建议将我们的干预转变为虚拟平台。此转换将启用 参与者在新冠肺炎期间获得及时的服务，并根据特定的因素促进健康 父母补助(即心血管健康、艾滋病毒和创伤)。我们提出两个补充目标，这将是 在综合混合方法设计中实现：(1)评估HHMB虚拟交付的影响 对临床结果的干预(例如，生活简单七、抑郁、焦虑、创伤后应激)；以及(2) 评估新冠肺炎对HHMB参与者的不断发展的影响：a)身心健康 艾滋病毒、心血管疾病风险因素和其他慢性病的存在和自我护理；b)日常生活，包括获得 保健、所需的社会服务和其他社区资源；以及c)参与和满足 使用HHMB干预的交付格式(面对面与虚拟)。

Project Summary During this unprecedented time of social distancing, investigators and health systems must understand the challenges faced by vulnerable patients and research participants and develop new strategies, including telehealth, to provide continuity of research engagement and care delivery that reduce risks for immunocompromised individuals, including people living with HIV (PLWH). The “Enhancing patient and organizational readiness for cardiovascular risk reduction among ethnic minority patients living with HIV” parent grant provides the Healing our Hearts, Minds, and Bodies (HHMB) intervention to Black and Latinx PLWH who have both trauma histories and cardiovascular risks. The goal of the trial is to increase patient and organizational readiness to address trauma and CVD risk among 260 Black and Latinx PLWH recruited from two HIV clinics in Southern California. For these vulnerable patients, it is incumbent upon our team to continue delivering the intervention while generating new knowledge in the context of the coronavirus (COVID-19) pandemic. The unpredictable onset and course of COVID-19, and the health and environmental effects that it presents for our vulnerable participants, have uncovered many important challenges in conducting health behavior research in high-risk, hard-to-reach populations. Current HHMB participants and those recruited for future HHMB groups now face additional environmental exposure risks that can interact with their HIV status and CVD risks, increasing negative health consequences, with severe ramifications that include death. Therefore, it is critical to provide culturally relevant programming that will encourage sustained engagement and maximize retention in research designed to reduce health risks as well as facilitate care. Retention efforts are likely to prevent and control chronic disease, and reduce morbidity and premature mortality, leading to improved overall health and wellness. In an effort to follow current safer-at-home mandates, mitigate environmental exposures, and provide continued health promotion, social support, and interaction during these uncertain times, we propose to convert our intervention to a virtual platform. This conversion will enable participants to receive services that are timely during COVID-19 and promote health on factors specific to the parent grant (i.e., cardiovascular health, HIV, and trauma). We propose two supplemental aims that will be achieved in an integrated mixed methods design: (1) to evaluate the impact of virtual delivery of the HHMB intervention on clinical outcomes (e.g., Life’s Simple 7, depression, anxiety, post-traumatic stress); and (2) to evaluate the evolving impact of COVID-19 on HHMB participants’: a) physical, mental, and emotional well- being and self-care for HIV, CVD risk factors, and other chronic conditions; b) daily lives, including their access to health care, needed social services, and other community resources; and c) engagement in and satisfaction with the delivery format (in person vs. virtual) of the HHMB intervention.