Translating the ABCSs into HIV Care: A Stepped Wedge Cluster Randomized Clinical Trial

Area of Science:

• Cardiovascular Health
• Infectious Disease Management
• Public Health Interventions

Background:

• People living with HIV (PLWH) exhibit elevated atherosclerotic cardiovascular disease (ASCVD) risk compared to the general population.
• Understanding and mitigating ASCVD risk factors in PLWH is critical for improving long-term health outcomes.

Purpose of the Study:

• To evaluate the "Million Hearts" multilevel strategy's impact on estimated 10-year ASCVD risk in PLWH.
• The strategy focused on aspirin use (A), blood pressure management (B), cholesterol reduction (C) with statins, and smoking cessation (S) – collectively known as ABCS.

Main Methods:

• A stepped-wedge cluster randomized clinical trial (SW-CRCT) was conducted across nine practices serving PLWH from 2019 to 2022.
• 485 PLWH aged 40-75 with a baseline 10-year ASCVD risk of ≥5% were enrolled.
• Interventions included patient coaching, automated texting, academic detailing for clinicians, and risk/adoption feedback.

Main Results:

• Analysis adjusted for COVID-19 pandemic delays showed a statistically significant reduction in 10-year ASCVD risk (-0.47; 95% CI -0.93 to -0.01).
• This risk reduction was primarily driven by significant decreases in cholesterol levels and smoking rates.
• No significant worsening of HIV viral load suppression was observed (p=0.6).

Conclusions:

• The "Million Hearts" multicomponent intervention effectively reduced ASCVD risk in PLWH.
• Despite implementation challenges due to the COVID-19 pandemic, the strategy demonstrated significant benefits.
• The intervention improved cardiovascular health markers without negatively impacting HIV viral suppression.