Implementation Research: Translating the ABC's into HIV Care

摘要/摘要 使用高效的、通常是单一药丸的艾滋病毒抗逆转录病毒疗法大大减少了艾滋病的死亡-- 导致艾滋病毒携带者(PLH)人口老龄化的相关原因 心血管疾病的发病率和死亡率。经年龄和性别调整后的心血管疾病死亡率明显更高。 在PLH人群中的发病率高于普通人群。PLH中日益增长的心血管疾病风险可能是实质性的 通过使用既定的干预措施减少，通常称为ABC，即适当使用 阿司匹林，控制血压，降低胆固醇，戒烟，除了生活方式，即饮食， 体力活动和安全饮酒。在公共卫生部门中，这些干预措施都没有得到充分利用。有一个 关于哪些战略将促进共同决策的科学知识方面的根本差距 关于PLH和他们的临床医生之间的ABC。解决这一差距对于减少日益增长的CVD至关重要 PLH之间的负担。该提案的总体目标是开发并严格测试实施情况 应对这一科学知识差距的战略。我们建议测试以下患者--临床医生--和 实践层面的策略：患者/激活培训和短信支持、以临床医生为目标的学术详细说明 以及审计和反馈，以及基于实践的参与。这个应用程序的科学前提是使用 以证据为基础的多层次实施战略将促进对ABC的讨论和理解 在PLH中。我们的调查团队有资格确保成功。我们在培训方面的经验很少- 收入和少数PLH利用数字技术成为“活跃的病人”。我们的团队在 使用实施战略对临床医生进行培训。我们在实施研究方面取得了成功。 在此基础上，我们将招聘8家不同规模和地点的艾滋病毒诊所，并招聘600名 患者，40-60名临床医生，并与他们建立合作伙伴关系，以实现以患者、临床医生和实践为中心 促进患者与临床医生讨论ABC的策略。我们将使用科学严谨的方法， 包括一项阶梯式楔形随机试验(SWT)，以评估对心血管风险变化的影响 使用经过验证的风险评估工具。我们的具体目标是：1)评估执行《公约》的影响 以证据为基础的多层次策略，以降低PLH中的心血管疾病风险；2)评估 使用RE-AIM QUEST实施这些策略。运用定量和定性的方法，我们 将通过评估覆盖范围、有效性(如上所述)、采纳率、 实施和维护。这些目标的实现将使翻译的科学得到证实 将心血管疾病预防干预措施付诸实践，以降低PLH中日益增长的心血管疾病风险，这一点突出表现在 NHLBI实施科学工作组。该提案在重点(PLH)方面具有创新性，它结合了 多层次战略及其在SWT中的应用。我们的提议对心血管疾病的贡献意义重大 实施科学及其在减少公共卫生部门心血管疾病公共健康影响方面的潜力。

SUMMARY/ABSTRACT Use of highly effective, often single pill HIV antiretroviral therapy has dramatically reduced deaths from AIDS- related causes yielding an aging population among people living with HIV (PLH) who increasingly experience cardiovascular (CVD) morbidity and mortality. Age and sex-adjusted deaths from CVD are appreciably higher among PLH than among the general population. This growing CVD risk among PLH can be substantively reduced through use of established interventions, commonly referred to as ABCS i.e. appropriate use of aspirin, blood pressure control, cholesterol reduction, and smoking cessation, in addition to lifestyle, ie diet, physical activity, and safe drinking. Each of these interventions is underused among PLH. There is a fundamental gap in scientific knowledge regarding which strategies will promote shared decision-making regarding ABCS between PLH and their clinicians. Addressing this gap is vital to reducing the growing CVD burden among PLH. The overall objective of this proposal is to develop and rigorously test implementation strategies to address this gap in scientific knowledge. We propose to test the following patient-, clinician-, and practice-level strategies: patient/activation training and texting support, clinician-targeted academic detailing and audit and feedback, and practice-based engagement. The scientific premise of this application is that use of evidence-based, multilevel implementation strategies will improve discussion and uptake of the ABCS among PLH. Our investigative team is qualified to ensure success. We are experienced in training largely low- income and minority PLH to become `activated patients' using digital technology. Our team is experienced in training to clinicians using implementation strategies. We have been successful in implementation research. Building on this foundation, we will recruit 8 HIV practices of varying sizes and location and recruit 600 patients, 40-60 clinicians and engage them in partnerships to implement patient, clinician and practice-focused strategies for promoting patient-clinician discussion of the ABCS. We will use scientifically rigorous methods, including a stepped wedge randomized trial (SWT) to evaluate the impact on changes in cardiovascular risk using a validated risk assessment tool. Our specific aims are: 1)To assess the impact of the implementation of an evidence-based, multilevel strategy to reduce CVD risk among PLH; 2)To assess the process of implementation of these strategies using RE-AIM QuEST. Using both quantitative and qualitative methods, we will assess the process of implementation by assessing Reach, Effectiveness (as above), Adoption, Implementation and Maintenance. Achievement of these aims will inform the science of translating proven CVD prevention interventions into practice to reduce growing CVD risk among PLH that was highlighted by an NHLBI Implementation Science Work Group. The proposal is innovative in its focus (PLH), its combination of multilevel strategies, and its application of the SWT. Our proposal is significant in its contribution to CVD implementation science and its potential for reducing public health impact of CVD among PLH.