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%的艾滋病毒携带者(PWH)存在食物不安全问题。威尔斯亲王医院那些食物不安全的人 更有可能具有较低的抗逆转录病毒依从性，降低病毒抑制，并增加 得了重病。越来越多的研究表明，艾滋病毒也会导致心脏代谢的发展 共病，但关于粮食不安全如何影响这些共病的发展，人们知之甚少。 在威尔斯亲王医院中。 这项研究的目的是为了更好地了解金融创新如何促进 PWH患者的心脏代谢性并存和测试一种新的双语FI干预方法 这些在食物不安全的威斯康星医院中的并存。我们将与维克森林合作进行这项研究 传染病专科诊所，瑞安·怀特资助的北卡罗来纳州最大的诊所之一，它 每年从包括中南部在内的以农村为主的集水区为超过2,000名威尔斯亲王提供服务 阿巴拉契亚。这个地区的FI和HIV感染率都很高。 在目标1中，我们将每年收集每个患者的纵向数据，时间长达3年。 爱滋病护理探访。利用这些数据，我们将比较心脏代谢疾病的患病率和发病率 粮食安全和不安全的威斯康星医院之间的共生关系。我们假设粮食不安全的PWH将会更多 可能有心脏代谢合并症，包括糖尿病前期和T2 DM，而不是食物安全的PWH 基线。我们还假设，那些FI的人将有更高的糖尿病前期和T2 DM的发病率 而不是那些随着时间的推移食物安全的人。在目标2中，使用随机对照试验设计，我们将测试 WeCare/Secure是双语循证干预的改进版本，集成了同行导航 和mHealth，以确定干预对食物不安全的PWH患者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。 这项拟议的研究补充了RFA的重点，促进了我们对FI如何 影响PWH和测试中的合并症的发展，FI的干预如何缓解NIDDK- 相关的合并症。这将是第一批评估FI如何导致 PWH患者的心脏代谢性共病。此外，我们将测试一种新的双语干预措施，以提高 降低FI对PWH胰岛素敏感性的影响。鉴于卫生系统对解决以下问题的兴趣越来越大 FI作为临床实践的常规部分，如果干预被发现是有效的，它可以广泛地 在艾滋病毒临床护理环境中传播。我们的老牌调查员团队有证明的记录 成功地在威尔斯亲王医院中进行了随机试验，成功地使用了本研究中提出的方法 申请，并得到将进行研究的临床地点的全力支持。

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.