A Nurse-Led Intervention to Extend the HIV Treatment Cascade for cardiovascular disease prevention (EXTRA-CVD)
Years: 2018-2023
Background
People living with HIV (PLWHIV or PLWH) are at high risk for developing cardiovascular disease (CVD). Although HIV-specific factors play a role in CVD, traditional risk factors–including hypertension and hyperlipidemia–account for the vast majority of risk. The EXTRA-CVD Study tests a nurse-led intervention to improve control of hypertension and hyperlipidemia in PLWHIV.
The intervention consists of four evidenced-based components:
- nurse-led care coordination,
- nurse-managed medication protocols and adherence support,
- home blood pressure monitoring, and
- electronic medical records support tools.
This study aims to:
- Conduct a baseline assessment of atherosclerotic cardiovascular disease (ASCVD) preventative care and perceptions of ASCVD risk in the HIV specialty clinic environment;
- Evaluate the 12-month efficacy of the EXTRA-CVD intervention to improve BP and cholesterol control in PLWHIV; and
- Conduct a process evaluation of the EXTRA-CVD intervention.
Research Design
EXTRA-CVD is a mixed-methods clinical effectiveness trial design using an intent to treat approach. For the trial component of the study, 300 participants were randomized 1:1 to the nurse-led intervention versus an educational control. The primary outcome will be the change in systolic blood pressure and the secondary outcome will be change in non-HDL cholesterol. Participants will complete measures at baseline, 4, 8, and 12 months. A mixed-methods process evaluation will be used to monitor program implementation and better understand the relationship between the intervention components and health outcomes. This study was registered at ClinicalTrials.gov #NCT03643705
Results
All EXTRA-CVD data are collected and data analysis for Aims 2 and 3 are currently underway.
Research Publications
- Davey, C.H., Longenecker, C.T., Brinza, E., McCabe, M., Hileman, C.O., Vedanthan, R., Bosworth, H.B. and Webel, A., The impact of COVID-19 on cardiovascular health behaviors in people living with HIV. AIDS care, pp.1-8.
- The influence of healthcare financing on cardiovascular disease prevention in people living with HIV. BMC Public Health. 2020 Nov 23;20(1):1768. doi: 10.1186/s12889-020-09896-8
- Aifah, A., Okeke, N. L., Rentrope, C. R., Schexnayder, J., Bloomfield, G. S., Bosworth, H., … & Webel, A. R. (2020). Use of a human-centered design approach to adapt a nurse-led cardiovascular disease prevention intervention in HIV clinics. Progress in Cardiovascular Diseases.
- Okeke N.L., Webel A.R., Bosworth H.B., Aifah A., Bloomfield G.S., Choi E., Gonzales S., Hale S., Hileman C.O., Kidwell V., Muiruri C., Oakes M., Schexnayder J., Smith V., Vedanthan R., Longenecker C.T. Rationale and Design of A Nurse-led Intervention to Extend the HIV Treatment Cascade for Cardiovascular Disease Prevention Trial (EXTRA-CVD). (2019) American Heart Journal.;216:91-101
Media
$3 million grant extends HIV intervention to prevent heart disease
Resources
Research Team
Principal Co-Investigators
- Allison Webel, PhD, RN, FAAN, University of Washington School of Nursing
- Christopher Longenecker, MD, University of Washington Department of Global Health and the Division of Cardiology
- Hayden Bosworth, PhD, Department of Population Health Sciences, Duke University
Co-Investigators
- Carrilynn Hileman, MD, MetroHealth Medical Center
- Rajesh Vedanthan, MD, MPH, New York University
- Gerald Bloomfield, MD, MPH, Duke University School of Medicine
- Lance Okeke, MD, MPH, Duke University School of Medicine
- Valerie Smith, DrPH, Duke University School of Medicine
Support
This study is funded by the National Heart, Lung, and Blood Institute (National Institutes of Health), U01HL142099-01.