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

项目摘要 在这份K23提案中，我概述了一个全面的五年培训计划，该计划将为我的过渡做好准备 一个独立的，R 01级的研究人员能够开发新的，可行的，可扩展的综合 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）。为了实现这个目标，我的培训目标是：1。发展正念方面的专业知识， 行为改变以降低CVD风险; 2.）获得随机对照试验（RCT）设计经验， 在OPWH中执行; 3.）熟练掌握炎症生物标志物研究，以更好地 了解HIV-CVD的病理生理学。在本申请中，我提出了一个重要的和创新的 研究战略，一个惊人的跨学科导师团队，和全面的教学计划，以支持 这些目标。背景：OPWH不成比例地受到归因于慢性HIV免疫的CVD的影响。 失调和导致的炎症。全身性炎症会因心理压力而加剧， 激活免疫反应并驱动促炎性CVD风险行为。有证据表明 表明正念可以是一种有效的干预措施，以减少心理困扰和支持， 行为和炎症介导的CVD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内容 （正念减压和糖尿病预防计划）开发和试点测试新的文本 信息增强干预称为“一心”（OM-OH），使用半结构化的反馈， 与OPWH的心理困扰访谈（N=20），以及我的多学科导师团队（目标1）。 接下来，我将通过一个开放的试点（N=5），通过离职面谈和离职前自我报告评估， OM-OH的可接受性，并根据需要进一步精制OM-OH（目标2）。最后，我将随机进行一个试点， 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， 与增强的常规护理相比，精制OM-OH，和B.）调查对心理的潜在影响 抑郁、炎症和行为CVD风险（目标3）。研究结果将为R 01提供基础 申请进行OM-OH降低OPWH中炎症介导的CVD风险的有效性试验。 培训和指导：我的培训计划将由我的共同小学导师博士领导。 格洛丽亚叶，这两位著名的研究人员都专注于艾滋病毒的干预开发和临床试验， 心血管疾病，分别。我也会得到A的支持）。一个专家共同导师团队， 合作者，B.）在马萨诸塞州总医院和哈佛医学院， 学校，C。有针对性的课程、科学会议、研讨会和计划出版物。涉及 NHLBI：K23符合NHLBI HIV/AIDS计划公布的研究重点， HIV相关心血管合并症。

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.