Theoretically Informed Behavioral Intervention to Enhance QOL and Prevent HIV-related Comorbidities

ABSTRACT Black and Hispanic men are at highest risk of comorbid conditions resulting from HIV. Cardiovascular disease has become the leading contributor to mortality among persons with HIV, as both conditions are often co-morbid. As a result, prominent HIV comorbid conditions include CVD, high blood pressure and type II diabetes mellitus. Compared with the general population, CVD risk is 1.5 to 2 times higher in people with HIV, and this risk increases with age. By the year 2030, an estimated 78% of persons with HIV will be 50 years old or older, and nearly 80% will have one or more chronic conditions. These overlapping health needs drive up the cost of care as total direct expenditures for HIV treatment in the US exceed those for persons without HIV by approximately $10.7 billion and cardiovascular and metabolic comorbidities further increase this financial burden. Increased risk of HIV-related comorbidities, such as heart disease, is driven by environmental and interpersonal factors that contribute to nicotine exposure, poor diet quality, low physical activity, insufficient sleep, high cholesterol levels, elevated blood pressure, high blood sugar, and increased body mass index. Even when HIV viral load is well-controlled, HIV-infection causes immune activation and chronic inflammation, which can cause a narrowing of blood vessels, and can result in high blood pressure, chest pain, and/or buildup of plaque in the heart, ultimately resulting in heart disease. The status quo as it pertains to traditional chronic illness prevention has been conventional patient teaching in the clinical setting. However, prevention efforts to reduce heart disease have not achieved population-level impact and have been less effective among persons with HIV. The LEARN Study was a pilot waitlist control trial testing a virtual environment for CVD and metabolic disease prevention education. Our LEARN findings suggested that participants are concerned about hypertension, type II diabetes, stroke, and cancer. Cancer risk reflected both the increased incidence of non–AIDS-defining malignancies among people with HIV and shared risk factors for cardiovascular comorbidities. We propose a follow-up study to these findings in LEARN 2 using innovative clinical and community collaboration, a multidisciplinary team, and a virtual environment designed to preemptively mitigate HIV‐related comorbidities with shared risk factors. Project objectives are to: 1) to utilize formative research to modify our intervention to address contextual factors that affect prevention of shared clinical risk factors for HIV‐comorbidities; 2) determine the efficacy of LEARN2, as prevention education for HIV-comorbidities; and 3) conduct a process evaluation of LEARN2 feasibility and acceptability, identifying which components are most successful in initiating change. This project represents a shift in the status quo and signifies a trailblazing effort that leverages a multidisciplinary team, virtual tools, and clinical and community collaborations to advance health optimization in populations experiencing health disparities, while informing research, clinical practice, and policy.