Rationale and design of a nurse-led intervention to extend the HIV treatment cascade for cardiovascular disease prevention trial (EXTRA-CVD) - 07/11/19

Doi : 10.1016/j.ahj.2019.07.005

Nwora Lance Okeke ^a, Allison R. Webel ^b, Hayden B. Bosworth ^a,^c, Angela Aifah ^d, Gerald S. Bloomfield ^a, Emily W. Choi ^e, Sarah Gonzales ^a,^c, Sarah Hale ^a,^c, Corrilynn O. Hileman ^f,^g, Virginie Lopez-Kidwell ^h, Charles Muiruri ^a, Megan Oakes ^a,^c, Julie Schexnayder ^b, Valerie Smith ^a,^c, Rajesh Vedanthan ^d, Chris T. Longenecker ^f,^i,^⁎
^a Duke University School of Medicine, Durham, NC, USA
^b Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
^c Durham VA Medical Center, Durham, NC, USA
^d New York University School of Medicine, New York, NY, USA
^e The University of Texas at Dallas, Dallas, TX, USA
^f Case Western Reserve University School of Medicine, Cleveland, OH, USA
^g MetroHealth Medical Center, Cleveland, OH, USA
^h University of North Texas, Denton, TX, USA
ⁱ University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH, USA

^∗Reprint requests: Dr Chris T. Longenecker, MD, Assistant Professor of Medicine, Case Western Reserve University School of Medicine, University Hospitals Harrington Heart and Vascular Institute, 2103 Cornell Rd. WRB Room 4-533, Cleveland, OH 44106, USA.Case Western Reserve University School of Medicine, University Hospitals Harrington Heart and Vascular Institute2103 Cornell Rd. WRB Room 4-533ClevelandOH44106USA

Background

Persons living with human immunodeficiency virus (PLHIV) are at increased risk of atherosclerotic cardiovascular disease (ASCVD). In spite of this, uptake of evidence-based clinical interventions for ASCVD risk reduction in the HIV clinic setting is sub-optimal.

Methods

EXTRA-CVD is a 12-month randomized clinical effectiveness trial that will assess the efficacy of a multi-component nurse-led intervention in reducing ASCVD risk among PLHIV. Three hundred high ASCVD risk PLHIV across three sites will be randomized 1:1 to usual care with generic prevention education or the study intervention. The study intervention will consist of four evidence-based components: (1) nurse-led care coordination, (2) nurse-managed medication protocols and adherence support (3) home BP monitoring, and (4) electronic health records support tools. The primary outcome will be change in systolic blood pressure and secondary outcome will be change in non-HDL cholesterol over the course of the intervention. Tertiary outcomes will include change in the proportion of participants in the following extended cascade categories: (1) appropriately diagnosed with hypertension and hyperlipidemia (2) appropriately managed; (3) at treatment goal (systolic blood pressure <130 mm Hg and non-HDL cholesterol < National Lipid Association targets).

Conclusions

The EXTRA-CVD trial will provide evidence appraising the potential impact of nurse-led interventions in reducing ASCVD risk among PLHIV, an essential extension of the HIV care continuum beyond HIV viral suppression.

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Plan

Rationale

The changing HIV workforce and the patient-provider experience for PLHIV

Perceived ASCVD risk

BP and cholesterol targets matter

A multipronged approach is required to address barriers to ASCVD prevention care

A human-centered design approach to intervention adaptation

Clinical trial

Process evaluation

Funding and author responsibilities

Discussion

	RCT# NCT03643705
	Funding: This work is supported in part by the National Institutes of Health (U01HL142099, K23HL137611, and K23HL123341).

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Vol 216

P. 91-101 - octobre 2019 Retour au numéro

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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) - 07/11/19

Background

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Plan

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