A team of nurses and physicians has received a four-year, $3 million grant from the National Heart, Lung, and Blood Institute to extend traditional HIV treatment protocols to improve the cardiovascular health of people living with HIV.
According to the investigators, people living with HIV are nearly twice as likely to experience cardiovascular disease as uninfected populations. The project is a joint effort of the School of Medicine and Frances Payne Bolton School of Nursing at Case Western Reserve University, and Duke University School of Medicine.
The nurse-led intervention calls for HIV-positive participants to be screened for cardiovascular risk factors and receive outpatient and in-home follow-up care to help reach blood pressure and cholesterol treatment targets over the course of one year.
"People living with HIV may think to themselves, 'I always thought I would die of AIDS, so why do I need to worry about heart disease?'" said Chris Longenecker, co-principal investigator on the award, assistant professor of medicine and pathology at Case Western Reserve School of Medicine and director of the Research & Innovation Center at University Hospitals Harrington Heart & Vascular Institute. "In fact, more are now dying of non-AIDS conditions like heart disease, but they still do not feel like they are at high risk. The result is that people living with HIV are prescribed cardiovascular prevention therapies at lower rates than the general public."
Part of the new study includes interviews with HIV patients and their care providers to assess cardiovascular risk perceptions as well as facilitators and barriers to care in this population.
"We've had significant and sustainable success in making HIV a chronic, treatable disease that we are now in a position to focus on preventing a growing problem in this population--cardiovascular disease," said Allison Webel, assistant professor of nursing and co-principal investigator on the award.
The study's third principal investigator is Hayden Bosworth at Duke University School of Medicine.
Finding care a challenge
A major challenge in connecting people living with HIV to proper care is a changing workforce, say the researchers. The number of HIV specialists is declining, despite a growing patient population reflective of improved public health and diagnostic strategies. Patients are most likely to receive their care from primary care physicians, nurse practitioners and physician assistants--a trend seen across medical specialties.
Aligned with these trends, the newly funded intervention relies on nurses to provide evidence-based cardiovascular care to HIV patients. Nurses will coordinate baseline cardiovascular assessments, manage medications, oversee at-home blood-pressure monitoring and measure adherence and outcomes using electronic medical records. Nurses will also, more broadly, provide support for study participants.
"Nurses are at the center of coordinating care for people living with HIV and serve as vital trust and communication links between HIV providers and primary care doctors," Webel said. "Nurses are able to keep patients engaged in self-management of their conditions, in this case, high blood-pressure and high cholesterol. For example, if a doctor prescribes a home blood-pressure cuff, nurses can follow-up with patients about whether they are using it, any challenges in using it and whether their medications need to be adjusted."
According to the researchers, models that promote shared responsibilities between HIV specialists and nurses exist, but their effect on non-AIDS outcomes like cardiovascular disease has not been rigorously studied.
"In many HIV clinics around the world," Webel said, "nurses are the bridge between the patient and the health-care system. We know nurse-led interventions can improve outcomes and reduce costs, and with proper adaptation, are scalable across the country."
The novel intervention will assess whether nurse-led interventions work in the context of cardiovascular comorbidities associated with HIV. HIV patients can enroll at one of three study sites: University Hospitals Cleveland Medical Center, MetroHealth Medical Center or Duke Health.
The researchers plan to begin enrolling HIV patients in the intervention by the end of this month. Their hope is that their outcomes could inform specific treatment guidelines for blood-pressure and cholesterol monitoring in HIV populations. They also hope to learn best practices to adapt cardiovascular interventions to this specialty population.
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