INcreasing Statin Prescribing in HIV Behavioral Economics REsearch

Study Overview
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Brief Summary
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Cardiovascular disease is a major cause of morbidity and mortality among people living with HIV. Recent studies have demonstrated that patients with HIV experience a 50-100% increased risk of myocardial infarction and stroke compared to HIV-uninfected persons. They also face higher risks of stroke, sudden death, and heart failure. However, evidence-based statin therapy-which is safe in this population and highly effective at reducing cardiovascular risk-is under-prescribed. The investigators propose a multi-level intervention to increase evidence-based statin prescribing by addressing barriers at these levels. The implementation intervention includes two strategies: (1) tailored education at the leadership, provider, and patient levels, and (2) behavioral economics-informed feedback for providers.

Official Title
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Behavioral Economics and Implementation Research to Reduce Cardiovascular Risk in HIV-Infected Adults

Conditions
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HIV, Cardiovascular Diseases

Intervention / Treatment
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* Behavioral: Knowledge assessment
* Behavioral: Education Intervention
* Behavioral: Provider Feedback


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age ≥ 40 years have been diagnosed with HIV LDL ≥ 190, diabetes and LDL ≥ 70 or 10-year ASCVD risk ≥ 7.5% or history of heart attack, stroke, or peripheral vascular disease care for patients with HIV at least 1/2 day each week (physicians) work at participating clinics (physicians) Exclusion Criteria: unable to provide written, informed consent not at participating clinic

Ages Eligible for Study
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Minimum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Stepped-wedge cluster randomized trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Organization Level<br> | Behavioral: Knowledge assessment<br>* Investigators will conduct semi-structured interviews with medical directors, clinical leadership and all participating physicians to gain insight on knowledge about and barriers to prescribing statins for people living with HIV. People living with HIV will participate in focus groups.<br>|
| Other: Provider Level<br> | Behavioral: Knowledge assessment<br>* Investigators will conduct semi-structured interviews with medical directors, clinical leadership and all participating physicians to gain insight on knowledge about and barriers to prescribing statins for people living with HIV. People living with HIV will participate in focus groups.<br>Behavioral: Education Intervention<br>* Education intervention will be adapted from the the findings of these interviews and focus groups. Clinics will be randomized to receive the education intervention and feedback implementation strategies at different times. Medical directors and providers will receive a brief educational intervention about cardiovascular disease risk in people living with HIV. Providers will additionally receive a web-based survey before and after the education intervention. Patients will receive pamphlets tailored to the effects of cardiovascular disease treatment for people living with HIV.<br>Behavioral: Provider Feedback<br>* Six months after the education intervention, providers will receive monthly emails with feedback regarding their rates of prescribing statins, with language targeted at increasing motivation to prescribe by leveraging social norms and self-image.<br>|
| Other: Patient Level<br> | Behavioral: Knowledge assessment<br>* Investigators will conduct semi-structured interviews with medical directors, clinical leadership and all participating physicians to gain insight on knowledge about and barriers to prescribing statins for people living with HIV. People living with HIV will participate in focus groups.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in proportion of PLWH with cardiovascular risk factors seen by a physician receiving statin therapy |  | 12 months |