NHLBI Grant Studies Pandemic Stressors in HIV Population

$500,000 award supplements ongoing $3 million study of cardiovascular care and risk management

Innovations in Cardiovascular Medicine & Surgery | Winter 2021

Researcher collaborators at University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine and Frances Payne Bolton School of Nursing, MetroHealth and Duke University recently received a one-year, $500,000 supplemental grant from the National Heart, Lung and Blood Institute (NHLBI).

Christopher Longenecker, MD

The team’s proposal was among 500 submissions to a Request for Applications aimed at accelerating study of COVID-19. Just 20 recipients were selected nationally in the highly competitive funding process. The award augments a $3 million parent grant currently studying cardiovascular disease (CVD) in patients with HIV.

“We know that people living with HIV are at higher risk for CVD than the general population,” says Christopher Longenecker, MD, Director of the Research & Innovation Center at UH Harrington Heart & Vascular Institute and co-principal investigator of the EXTRA-CVD and supplemental study, and Associate Professor, Case Western Reserve University School of Medicine. “However, a unique barrier in our population is the feeling that ‘I always thought I would die of AIDS.’ As life expectancy for HIV approaches that of the general population, we need to be thinking more strongly about these risk factors.”

For the EXTRA-CVD study, Dr. Longenecker and his co-principal investigators — Allison Webel, PhD, RN, FAAN, School of Nursing; and Hayden Bosworth, PhD, Department of Population Health Sciences, Duke University — are conducting a randomized trial to improve cardiovascular health for patients living with HIV. Through outpatient and in-home interaction, nurse-led interventions screen for cardiovascular risk factors and help patients reach healthy targets for blood pressure and cholesterol over one year.

 

“We want to make sure that medications are titrated to achieve our goals clinically,” Dr. Longenecker says. “Additionally, we are testing whether or not these interventions are better than usual care.”

Investigating Pandemic-related Stressors

For the supplemental grant, the team is investigating how social isolation and changes to healthcare delivery are impacting patients currently enrolled in the primary study. “We had already recruited a large number of subjects prior to COVID-19,” Dr. Longenecker says. “Suddenly, medical care changed in unusual ways. Patients weren’t coming into clinic, and they were feeling a lot of anxiety related to the pandemic. Our idea was to try to study this within the context of our clinical trial.”

Using standardized methods, the team is collecting detailed data on social isolation, anxiety and other pandemic-related stressors and studying how those factors influence patients’ ability to manage their health risks. “We are also doing qualitative research to determine through interviews with these patients some of the unexpected challenges of the pandemic, but maybe also opportunities to better manage their HIV and cardiovascular health,” Dr. Longenecker says.

Interviews are being conducted with eight patients at each clinical site, for a total of 24 participants. Investigators also have the opportunity for a potential second year of funding.

Looking ahead, the team plans to reimagine ongoing nurse intervention via remote connectivity. In place of clinic visits, patients will be able to connect through phone calls and virtual platforms. Technology coaches will be available to help patients utilize videoconferencing applications. Additionally, virtual support groups will help address social isolation and anxiety. Patients will also continue to monitor their blood pressure at home.

“We know that monitoring your BP at home can help lower systolic blood pressure by four to six millimeters of mercury,” Dr. Longenecker says. “We are adding to the literature that already exists on the value of home blood pressure monitoring.”

Improving Outcomes for Vulnerable Populations

What are some of the early lessons of COVID-19 as they relate to public health? Stress, social isolation and constraints on care delivery negatively impact vulnerable populations, including patients with HIV.

“We have always been aware that social determinants of health disproportionately limit access to care,” Dr. Longenecker says. “I think that what the pandemic has revealed is that these disparities are magnified during times of crisis. We need to address this in our patient population moving forward to help individuals achieve optimal health outcomes.”

For more information or to refer a patient, please contact Dr. Longenecker at 216-844-1227.