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Protocol paper: Stepped wedge cluster randomized trial translating the ABCS into optimizing cardiovascular care for
Stephen K Williams1, Brent A Johnson2, Jonathan N Tobin3
1Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY.
Insights
Implementing the ABCS (aspirin, blood pressure control, cholesterol control, smoking cessation) can reduce cardiovascular risk in people living with HIV (PWH). This study evaluated multilevel strategies to promote ABCS use among PWH and their clinicians.
Area of Science:
- Public Health
- Cardiology
- Implementation Science
Background:
- People living with HIV (PWH) face elevated risks for cardiovascular disease (CVD) and stroke compared to the general population.
- The ABCS (aspirin, blood pressure control, cholesterol control, smoking cessation) are proven to reduce atherosclerotic CVD (ASCVD) risk, but their promotion among PWH is understudied.
Purpose of the Study:
- To design and evaluate multilevel implementation strategies promoting the ABCS among PWH based on 10-year ASCVD risk.
- To assess the effectiveness of patient coaching, automated texting, peer support, academic detailing, and audit/feedback for clinicians.
Main Methods:
- A stepped wedge cluster randomized trial utilizing the RE-AIM/QuEST mixed methods framework.
- Integration of quantitative and qualitative assessments to evaluate implementation and impact.
- Focus on changes in ASCVD risk as the primary outcome.
Main Results:
- Implementation strategies were designed to target both PWH and their clinicians.
- The study employs a robust mixed-methods approach for comprehensive evaluation.
- Findings are expected to inform strategies for ASCVD risk reduction in PWH.
Conclusions:
- Effective strategies are needed to promote the ABCS in people living with HIV to mitigate cardiovascular risks.
- Multilevel interventions targeting patients and providers are crucial for successful implementation.
- This research will provide critical insights into reducing ASCVD risk in this vulnerable population.
Abstract:
People living with HIV (PWH) are at higher risk for cardiovascular disease (CVD) and stroke in comparison to their non-infected counterparts. The ABCS (aspirin-blood pressure control-cholesterol control-smoking cessation) reduce atherosclerotic (ASCVD) risk in the general population, but little is known regarding strategies for promoting the ABCS among PWH. Guided by the Consolidated Framework for Implementation Research (CFIR), we designed multilevel implementation strategies that target PWH and their clinicians to promote appropriate use of the ABCS based on a 10-year estimated ASCVD risk. Implementation strategies include patient coaching, automated texting, peer phone support, academic detailing and audit and feedback for the patient's clinician. We are evaluating implementation through a stepped wedge cluster randomized trial based on the Reach-Effectiveness-Adoption-Maintenance/Qualitative-Evaluation-for-Systematic-Translation (RE-AIM/QuEST) mixed methods framework that integrates quantitative and qualitative assessments. The primary outcome is change in ASCVD risk. Findings will have important implications regarding strategies for reducing ASCVD risk among PWH.
