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

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.