SCOPE OF WORK The overall research objective is to determine optimal models of care for ASCVD primary prevention in HIV- infected persons and to investigate the role of clinical case managers in improving ASCVD preventative care in the HIV clinic setting. The proposed study will employ the innovative approach of telephone-based interventions for the augmentation of in-clinic care to address ASCVD risk reduction in HIV-infected persons, a high-risk group for ASCVD.
The aims of the study are to: 1) Determine the association between the single- provider model for HIV care (HIV clinician as primary care provider) and ASCVD risk factor outcomes; 2) Identify experiences and perceptions of HIV-infected persons on current models of non-AIDS associated chronic disease care delivery; 3) assess the impact of telephone-based case manager-administered interventions in improving ASCVD risk factor outcomes among HIV-infected clinic patients.
ABSTRACT This application is for a K23 award for Nwora Lance Okeke, MD, MPH, an Instructor of Medicine in the Division of Infectious Diseases at Duke University, who is training to become an independent investigator in cardiovascular disease among persons living with HIV. Although effective antiretroviral therapy has transformed HIV infection from a disease with a dismal prognosis to a manageable chronic disease, persons with chronically suppressed HIV are at a 40% higher risk of myocardial infarction and stroke than uninfected persons. Though much effort has been focused on determining the pathophysiology of atherosclerosis in HIV- infected persons, innovative strategies are needed to adapt the HIV clinical care team to the evolving medical needs of the HIV population, including comprehensive atherosclerotic cardiovascular disease (ASCVD) risk management. An essential part of employing effective initiatives to incorporate ASCVD primary prevention into HIV care is understanding what models of chronic disease care have worked in the past. In addition, exploring clinic-based strategies that have proven to be effective in reducing ASCVD risk in uninfected persons will provide insight on what strategies will be successful in HIV-infected persons, especially if they customized to fit the skills of the multidisciplinary HIV clinical care team. The overall research objective is to determine optimal models of care for ASCVD primary prevention in HIV-infected persons and to investigate the role of clinical case managers in improving ASCVD preventative care in the HIV clinic setting. The proposed study will employ the innovative approach of telephone-based interventions for the augmentation of in-clinic care to address ASCVD risk reduction in HIV-infected persons, a high-risk group for ASCVD. The aims of the study are to: 1) Determine the association between the single-provider model for HIV care (HIV clinician as primary care provider) and ASCVD risk factor outcomes; 2) Identify experiences and perceptions of HIV-infected persons on current models of non-AIDS associated chronic disease care delivery; 3) assess the impact of telephone-based case manager-administered interventions in improving ASCVD risk factor outcomes among HIV-infected clinic patients. Hayden Bosworth Ph.D, a Professor of Medicine at Duke with over 270 peer review publications in health services research in ASCVD risk management, will be Dr Okeke's primary mentor for the project. The mentoring team will also have two established investigators with appropriate expertise to guide Dr. Okeke's research agenda: Susanna Naggie MD, Associate Professor of Medicine at Duke, a renowned expert in HIV/HCV co-infection and with vast experience in HIV clinical trials; and Melissa Watt Ph.D, an accomplished investigator in mental health and substance abuse among HIV-infected persons with significant expertise in qualitative methods to inform behavioral interventions in this population. Dr Okeke has delineated a training plan complementing his research agenda, specifically to acquire skills in health services research methodology, qualitative methods, clinical trial design and implementation science. Training will be accomplished through a series of didactic courses and relevant practicums. The proposed plan will allow Dr. Okeke to develop into an independent investigator with the research expertise, professional skills and preliminary data to compete for an R01 to implement his clinic-based interventions for CVD risk reduction in the rapidly aging HIV population.
| Okeke, Nwora Lance; Alenezi, Fawaz; Bloomfield, Gerald S et al. (2018) Determinants of Left Ventricular Hypertrophy and Diastolic Dysfunction in an HIV Clinical Cohort. J Card Fail 24:496-503 |
