Schexnayder Julie, Longenecker Chris T, Muiruri Charles, Bosworth Hayden B, Gebhardt Daniel, Gonzales Sarah E, Hanson Jan E, Hileman Corrilynn O, Okeke Nwora Lance, Sico Isabelle P, Vedanthan Rajesh, Webel Allison R
Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106-7343, USA.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Implement Sci Commun. 2021 Feb 12;2(1):17. doi: 10.1186/s43058-021-00114-z.
People with HIV (PWH) experience increased cardiovascular disease (CVD) risk. Many PWH in the USA receive their primary medical care from infectious disease specialists in HIV clinics. HIV care teams may not be fully prepared to provide evidence-based CVD care. We sought to describe local context for HIV clinics participating in an NIH-funded implementation trial and to identify facilitators and barriers to integrated CVD preventive care for PWH.
Data were collected in semi-structured interviews and focus groups with PWH and multidisciplinary healthcare providers at three academic medical centers. We used template analysis to identify barriers and facilitators of CVD preventive care in three HIV specialty clinics using the Theoretical Domains Framework (TDF).
Six focus groups were conducted with 37 PWH. Individual interviews were conducted with 34 healthcare providers and 14 PWH. Major themes were captured in seven TDF domains. Within those themes, we identified nine facilitators and 11 barriers to CVD preventive care. Knowledge gaps contributed to inaccurate CVD risk perceptions and ineffective self-management practices in PWH. Exclusive prioritization of HIV over CVD-related conditions was common in PWH and their providers. HIV care providers assumed inconsistent roles in CVD prevention, including for PWH with primary care providers. HIV providers were knowledgeable of HIV-related CVD risks and co-located health resources were consistently available to support PWH with limited resources in health behavior change. However, infrequent medical visits, perceptions of CVD prevention as a primary care service, and multiple co-location of support programs introduced local challenges to engaging in CVD preventive care.
Barriers to screening and treatment of cardiovascular conditions are common in HIV care settings and highlight a need for greater primary care integration. Improving long-term cardiovascular outcomes of PWH will likely require multi-level interventions supporting HIV providers to expand their scope of practice, addressing patient preferences for co-located CVD preventive care, changing clinic cultures that focus only on HIV to the exclusion of non-AIDS multimorbidity, and managing constraints associated with multiple services co-location.
ClinicalTrials.gov , NCT03643705.
感染艾滋病毒的人（PWH）患心血管疾病（CVD）的风险增加。美国许多感染艾滋病毒的人在艾滋病毒诊所接受传染病专家的初级医疗护理。艾滋病毒护理团队可能没有完全准备好提供循证心血管疾病护理。我们试图描述参与美国国立卫生研究院资助的实施试验的艾滋病毒诊所的当地情况，并确定为感染艾滋病毒的人提供综合心血管疾病预防护理的促进因素和障碍。
在三个学术医疗中心对感染艾滋病毒的人和多学科医疗服务提供者进行了半结构化访谈和焦点小组访谈，收集数据。我们使用模板分析，利用理论领域框架（TDF）确定三家艾滋病毒专科诊所心血管疾病预防护理的障碍和促进因素。
对37名感染艾滋病毒的人进行了6次焦点小组访谈。对34名医疗服务提供者和14名感染艾滋病毒的人进行了个人访谈。主要主题涵盖TDF的七个领域。在这些主题中，我们确定了心血管疾病预防护理的九个促进因素和十一个障碍。知识差距导致感染艾滋病毒的人对心血管疾病风险的认知不准确，自我管理做法无效。在感染艾滋病毒的人和他们的医疗服务提供者中，普遍将艾滋病毒置于高于心血管疾病相关病症的优先级。艾滋病毒护理提供者在心血管疾病预防中扮演的角色不一致，包括对有初级保健提供者的感染艾滋病毒的人。艾滋病毒提供者了解与艾滋病毒相关的心血管疾病风险，并且始终有共同地点的健康资源来支持资源有限的感染艾滋病毒的人进行健康行为改变。然而，就诊不频繁、将心血管疾病预防视为初级保健服务、以及支持项目的多个共同地点给参与心血管疾病预防护理带来了当地挑战。
在艾滋病毒护理环境中，心血管疾病筛查和治疗的障碍很常见，这突出表明需要加强初级保健整合。改善感染艾滋病毒的人的长期心血管疾病结局可能需要多层次干预，支持艾滋病毒提供者扩大其执业范围，解决患者对共同地点心血管疾病预防护理的偏好，改变只关注艾滋病毒而排除非艾滋病合并症的诊所文化，以及管理与多个服务共同地点相关的限制。
ClinicalTrials.gov，NCT03643705。
