The Development and Implementation of a Culturally-Congruent Educational Film designed for PLWHIV to Address Patients' Trauma Histories, Barriers to Care, and CVD Risk Reduction

摘要/项目总结(家长奖) 心血管疾病(CVD)已成为日益重要的致病原因 和艾滋病毒携带者(PLWHIV)的死亡率。现在艾滋病毒被认为是 可控制的慢性病，共患疾病的识别和治疗 包括CVD在内的血管病变日益成为研究和临床关注的焦点。缺少的是， 然而，护理PLWHIV的另一个关键组成部分是：对 精神创伤。创伤经历增加了感染艾滋病毒的可能性和心血管疾病的风险，但 对艾滋病病毒的保健很少协调以解决艾滋病毒这三个相互交织的问题， 心血管疾病和创伤，特别是在那些受艾滋病毒影响不成比例的人，即族裔 少数族裔患者。PLWHIV中的创伤病史与不一致有关 治疗依从性和不依从性以及创伤病史本身与较差的心血管疾病有关 结果。未能解决创伤问题对采用心血管疾病风险构成了重大障碍 艾滋病病毒感染者之间的战略。协调和整合艾滋病毒和艾滋病之间护理的卫生系统 慢性疾病，如心血管疾病，可能提供解决复杂疾病所需的基础设施 这些情况及其治疗的相互作用。我们设计了一部融合了文化和文化的小说 一致的、循证的护理模式，“治愈我们的心、头脑和身体”(HHMB)，以 解决患者的创伤病史和护理障碍，并为患者做好参与的准备 降低心血管疾病风险。认识到有必要确保艾滋病毒感染者获得心血管疾病指导方针-- 协调护理，我们还确定了实施战略，以准备提供者和 解决艾滋病毒阳性患者心血管疾病风险的诊所。因此，使用混合类型 II有效性/实施研究设计，本研究的目标是增加两个患者 以及组织准备好应对艾滋病患者中的创伤和心血管疾病风险。具体的 目标是：(1)评估和加强组织应对创伤和心血管疾病的准备情况 少数民族PLWHIV的风险；具体地说，分阶段办法将推动使用 旨在教育、监控和支持供应商和员工的实施战略 遵守心血管疾病护理指南；(2)使用混合方法，以(A)评估使用和 随着时间的推移，执行战略的有效性，以及(B)确定障碍和促进者 组织采用准则、提供商遵守准则、可行性和 可持续性；以及(3)评估HHMB对认知行为、情绪和 260名PLWHIV患者的身体结果，特别是患者的激活度、护理参与度、 心血管疾病风险知识，遵守临床医生的建议，心血管健康， 心理健康症状和对护理的满意度。我们将使用RE-AIM框架来指导 指导使用的评估和复制有效方案(REP)框架 实施战略和在我们参与的范围内调整护理模式 实施设置。

Abstract/Project Summary (Parent Award) Cardiovascular disease (CVD) has emerged as an increasingly important cause of morbidity and mortality among people living with HIV (PLWHIV). Now that HIV is considered a manageable chronic disease, the identification and treatment of comorbid medical conditions including CVD are increasingly the focus of research and clinical attention. What is missing, however, is yet another critical component of care for PLWHIV: integrated care for histories of trauma. Experiences of trauma increase the likelihood of HIV infection as well as CVD risk, yet health care for PLWHIV is rarely coordinated to address these three intersecting issues of HIV, CVD, and trauma, particularly among those disproportionately affected by HIV, i.e., ethnic minority patients. Histories of trauma among PLWHIV are associated with inconsistent treatment adherence and non-adherence, and trauma history alone is associated with poor CVD outcomes. Failure to address trauma poses significant barriers to the adoption of CVD risk strategies among PLWHIV. Health systems that coordinate and integrate care across HIV and chronic conditions such as CVD may provide the infrastructure needed to address the complex interplay of these conditions and their therapies. We have designed a novel blended, culturally congruent, evidence-informed care model, “Healing our Hearts, Minds and Bodies” (HHMB), to address patients' trauma histories and barriers to care, and to prepare patients to engage in CVD risk reduction. Recognizing the need to ensure that PLWHIV receive CVD guideline- concordant care, we have also identified implementation strategies to prepare providers and clinics for addressing CVD risk among their HIV-positive patients. Therefore, using a hybrid type II effectiveness/implementation study design, the goal of this study is to increase both patient and organizational readiness to address trauma and CVD risk among PLWHIV. The Specific Aims are: (1) to assess and enhance organizational readiness for addressing trauma and CVD risk among ethnic minority PLWHIV; specifically, a phased approach will drive the use of implementation strategies designed to educate, monitor, and support providers and staff in adhering to CVD care guidelines; (2) using mixed methods, to (a) evaluate the use and effectiveness of implementation strategies over time, and (b) identify barriers and facilitators to organizational adoption of guidelines, provider adherence to guidelines, feasibility, and sustainability; and (3) to evaluate the effect of HHMB on cognitive-behavioral, emotional, and physical outcomes among 260 PLWHIV, specifically patient activation, engagement in care, knowledge of CVD risk, adherence to clinicians' recommendations, cardiovascular health, mental health symptoms, and satisfaction with care. We will use the RE-AIM framework to guide the evaluation and the Replicating Effective Programs (REP) Framework to guide the use of implementation strategies and the tailoring of the care model within our participating implementation settings.