Reducing cardiovascular risk among people living with HIV: Rationale and design of the INcreasing Statin Prescribing in HIV Behavioral Economics REsearch (INSPIRE) randomized controlled trial

Prog Cardiovasc Dis. 2020 Mar-Apr;63(2):109-117. doi: 10.1016/j.pcad.2020.02.012. Epub 2020 Feb 19.

Abstract

Cardiovascular disease (CVD) is a major cause of morbidity among people living with HIV (PLWH). Statins can safely and effectively reduce CVD risk in PLWH, but evidence-based statin therapy is under-prescribed in PLWH. Developed using an implementation science framework, INcreasing Statin Prescribing in HIV Behavioral Economics REsearch (INSPIRE) is a stepped-wedge cluster randomized trial that addresses organization-, clinician- and patient-level barriers to statin uptake in Los Angeles community health clinics serving racially and ethnically diverse PLWH. After assessing knowledge about statins and barriers to clinician prescribing and patient uptake, we will design, implement and measure the effectiveness of (1) educational interventions targeting leadership, clinicians, and patients, followed by (2) behavioral economics-informed clinician feedback on statin uptake. In addition, we will assess implementation outcomes, including changes in clinician acceptability of statin prescribing for PLWH, clinician acceptability of the education and feedback interventions, and cost of implementation.

Keywords: Behavioral economics; Cardiovascular disease; HIV; Implementation science; Statins.

Publication types

  • Clinical Trial Protocol
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-HIV Agents / adverse effects
  • Anti-HIV Agents / therapeutic use*
  • Attitude of Health Personnel*
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Cardiovascular Diseases / psychology
  • Drug Prescriptions
  • Economics, Behavioral*
  • Education, Medical, Continuing
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / psychology
  • HIV Long-Term Survivors / psychology*
  • Health Knowledge, Attitudes, Practice
  • Health Status
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Implementation Science
  • Inservice Training
  • Los Angeles / epidemiology
  • Medication Adherence
  • Multicenter Studies as Topic
  • Patient Education as Topic
  • Practice Patterns, Physicians'*
  • Preventive Health Services*
  • Protective Factors
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Viral Load

Substances

  • Anti-HIV Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors