Rationale and design of a nurse-led intervention to extend the HIV treatment cascade for cardiovascular disease prevention trial (EXTRA-CVD)

Okeke, Nwora Lance; Webel, Allison R.; Bosworth, Hayden B.; Aifah, Angela; Bloomfield, Gerald S.; Choi, Emily W.; Gonzales, Sarah; Hale, Sarah; Hileman, Corrilynn Olesky; Lopez-Kidwell, Virginie; Muiruri, Charles; Oakes, Megan; Schexnayder, Julie; Smith, Valerie A.; Vedanthan, Rajesh; Longenecker, Chris T.

doi:10.1016/j.ahj.2019.07.005

Cited by 20 publications

(27 citation statements)

References 45 publications

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“…28 Qualitative data for this study were obtained from baseline formative research conducted to inform the adaptation of a one of the PRECLuDe funded trials -A nurse-led intervention trial to extend the HIV treatment cascade for cardiovascular disease prevention (EXTRA-CVD). 19,28,29 EXTRA-CVD is an implementation trial of a multicomponent, nurse-led intervention to control hypertension and hypercholesterolemia in individuals with well-controlled HIV infection.…”

Section: Methodsmentioning

confidence: 99%

“…During the interviews, participants were asked about CVD risk reduction behavior, how their HIV providers engaged them in discussing and managing CVD, their perceptions of their CVD risk, CVD medication adherence, and barriers and facilitators of adhering to CVD prevention. 19…”

Section: Data Collectionmentioning

confidence: 99%

“…For PLWH who are adherent to ART and have achieved viral suppression, nonadherence to CVD medications may be influenced by a combination of healthcare providers and individual patient factors including the health delivery systems. 19 On the healthcare provider level, HIV healthcare providers have an important role in encouraging and monitoring ART adherence as described in their practice guidelines. 20,21 HIV providers' role in monitoring and encouraging adherence to other non-AIDS conditions such as CVD for PLWH who have achieved viral suppression is understudied.…”

Section: Introductionmentioning

confidence: 99%

“…In order to develop a better understanding of the factors that influence adherence to CVD medications for PLWH who have achieved viral suppression, we analyzed qualitative data from an ongoing multi-site nurse-led intervention trial to improve cardiovascular health. 19 The objective of this current study was to identify factors associated with adherence to CVD medications for PLWH who have achieved viral suppression.…”

Section: Introductionmentioning

confidence: 99%

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<p>Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry</p>

Muiruri¹,

Sico²,

Schexnayder³

et al. 2020

PPA

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Background: After achieving viral suppression, it is critical for persons living with HIV (PLWH) to focus on prevention of non-AIDS comorbidities such as cardiovascular disease (CVD) in order to enhance their quality of life and longevity of life. Despite PLWH elevated risk of developing CVD compared to individuals without HIV, PLWH do not often meet evidence-based treatment goals for CVD prevention; the reasons for PLWH not meeting guideline recommendations are poorly understood. The objective of this study was to identify the factors associated with adherence to CVD medications for PLWH who have achieved viral suppression. Methods: Qualitative data were obtained from formative research conducted to inform the adaptation of a nurse-led intervention trial to improve cardiovascular health at three large academic medical centers in the United States. Transcripts were analyzed using content analysis guided by principles drawn from grounded theory. Results: Fifty-one individuals who had achieved viral suppression (<200 copies/mL) participated: 37 in 6 focus groups and 14 in individual semi-structured interviews. Mean age was 57 years (SD: 7.8); most were African Americans (n=31) and majority were male (n=34). Three main themes were observed. First, participants reported discordance between their healthcare providers' recommendations and their own preferred strategies to reduce CVD risk. Second, participants intentionally modified frequency of CVD medication taking which appeared to be related to low CVD risk perception and perceived or experienced side effects with treatment. Finally, participants discussed the impact of long-term experience with HIV care on adherence to CVD medication and motivational factors that enhanced adherence to heart healthy behaviors. Conclusion: Findings suggest that future research should focus on developing interventions to enhance patient-provider communication in order to elicit beliefs, concerns and preferences for CVD prevention strategies. Future research should seek to leverage and adapt established evidence-based practices in HIV care to support CVD medication adherence.

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Section: Methodsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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<p>Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry</p>

Muiruri¹,

Sico²,

Schexnayder³

et al. 2020

PPA

Self Cite

View full text Add to dashboard Cite

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“…This qualitative analysis was drawn from the formative evaluation of CVD prevention in the Nurse-led Intervention to Extend the HIV Treatment Cascade for CVD Prevention (EXTRA-CVD) study. The EXTRA-CVD study is a randomized clinical effectiveness trial testing the efficacy of a multi-component, nurse-led intervention to reduce hypertension and high cholesterol in adults living with HIV [ 12 ]. It is part of the NHLBI-funded PRECluDE initiative dedicated to catalyzing the implementation of effective interventions for co-occurring CVD and lung diseases among PLWH [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

The influence of healthcare financing on cardiovascular disease prevention in people living with HIV

et al. 2020

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Background People living with HIV are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates. Medical management of these chronic health conditions frequently occur in HIV specialty clinics by providers trained in general internal medicine, family medicine, or infectious disease. In recent years, changes in the healthcare financing for people living with HIV in the U.S. has been dynamic due to changes in the Affordable Care Act. There is little evidence examining how healthcare financing characteristics shape primary and secondary cardiovascular disease prevention among people living with HIV. Our objective was to examine the perspectives of people living with HIV and their healthcare providers on how healthcare financing influences cardiovascular disease prevention. Methods As part of the EXTRA-CVD study, we conducted in-depth, semi-structured interviews with 51 people living with HIV and 34 multidisciplinary healthcare providers and at three U.S. HIV clinics in Ohio and North Carolina from October 2018 to March 2019. Thematic analysis using Template Analysis techniques was used to examine healthcare financing barriers and enablers of cardiovascular disease prevention in people living with HIV. Results Three themes emerged across sites and disciplines (1): healthcare payers substantially shape preventative cardiovascular care in HIV clinics (2); physician compensation tied to relative value units disincentivizes cardiovascular disease prevention efforts by HIV providers; and (3) grant-based services enable tailored cardiovascular disease prevention, but sustainability is limited by sponsor priorities. Conclusions With HIV now a chronic disease, there is a growing need for HIV-specific cardiovascular disease prevention; however, healthcare financing complicates effective delivery of this preventative care. It is important to understand the effects of evolving payer models on patient and healthcare provider behavior. Additional systematic investigation of these models will help HIV specialty clinics implement cardiovascular disease prevention within a dynamic reimbursement landscape. Trial registration Clinical Trial Registration Number: NCT03643705.

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Nurse-Led Strategy to Improve Blood Pressure and Cholesterol Level Among People With HIV

Longenecker,

Jones,

Hileman

et al. 2024

JAMA Netw Open

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ImportanceDespite higher atherosclerotic cardiovascular disease (ASCVD) risk, people with HIV (PWH) experience unique barriers to ASCVD prevention, such as changing models of HIV primary care.ObjectiveTo test whether a multicomponent nurse-led strategy would improve systolic blood pressure (SBP) and non–high-density lipoprotein (HDL) cholesterol level in a diverse population of PWH receiving antiretroviral therapy (ART).Design, Setting, and ParticipantsThis randomized clinical trial enrolled PWH at 3 academic HIV clinics in the US from September 2019 to January 2022 and conducted follow-up for 12 months until January 2023. Included patients were 18 years or older and had a confirmed HIV diagnosis, an HIV-1 viral load less than 200 copies/mL, and both hypertension and hypercholesterolemia. Participants were stratified by trial site and randomized 1:1 to either the multicomponent EXTRA-CVD (A Nurse-Led Intervention to Extend the HIV Treatment Cascade for Cardiovascular Disease Prevention) intervention group or the control group. Primary analyses were conducted according to the intention-to-treat principle.InterventionThe EXTRA-CVD group received home BP monitoring guidance and BP and cholesterol management from a dedicated prevention nurse at 4 in-person visits (baseline and 4, 8, and 12 months) and frequent telephone check-ins up to every 2 weeks as needed. The control group received general prevention education sessions from the prevention nurse at each of the 4 in-person visits.Main Outcomes and MeasuresStudy-measured SBP was the primary outcome, and non–HDL cholesterol level was the secondary outcome. Measurements were taken over 12 months and assessed by linear mixed models. Prespecified moderators tested were sex at birth, baseline ASCVD risk, and trial site.ResultsA total of 297 PWH were randomized to the EXTRA-CVD arm (n = 149) or control arm (n = 148). Participants had a median (IQR) age of 59.0 (53.0-65.0) years and included 234 males (78.8%). Baseline mean (SD) SBP was 135.0 (18.8) mm Hg and non–HDL cholesterol level was 139.9 (44.6) mg/dL. At 12 months, participants in the EXTRA-CVD arm had a clinically significant 4.2-mm Hg (95% CI, 0.3-8.2 mm Hg; P = .04) lower SBP and 16.9-mg/dL (95% CI, 8.6-25.2 mg/dL; P &lt; .001) lower non–HDL cholesterol level compared with participants in the control arm. There was a clinically meaningful but not statistically significant difference in SBP effect in females compared with males (11.8–mm Hg greater difference at 4 months, 9.6 mm Hg at 8 months, and 5.9 mm Hg at 12 months; overall joint test P = .06).Conclusions and RelevanceResults of this trial indicate that the EXTRA-CVD strategy effectively reduced BP and cholesterol level over 12 months and should inform future implementation of multifaceted ASCVD prevention programs for PWH.Trial RegistrationClinicalTrials.gov Identifier: NCT03643705

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Rationale and design of a nurse-led intervention to extend the HIV treatment cascade for cardiovascular disease prevention trial (EXTRA-CVD)

Cited by 20 publications

References 45 publications

<p>Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry</p>

<p>Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry</p>

The influence of healthcare financing on cardiovascular disease prevention in people living with HIV

Nurse-Led Strategy to Improve Blood Pressure and Cholesterol Level Among People With HIV

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