Strengthening Hearts and Minds: A Health Promotion Strategy for Older Adults with HIV

About This Grant

Abstract Over half of people living with HIV in the U.S. are now 50 or older, and this number is projected to increase to 70% by 2030. Aging with HIV presents a unique array of physical and mental health challenges. High prevalence of cardiovascular risk factors (e.g., obesity, dyslipidemia, hypertriglyceridemia, vascular dysfunction) and worsened mental health increase vulnerability to cardiovascular disease (CVD), depression and anxiety. Therefore, innovative, evidence-based interventions are needed to address the realities of aging with HIV and offer timely, practical solutions for improving physical, mental, and HIV-related outcomes. In the proposed study, 180 older adults with HIV age 50+ with documented cardiovascular risk will be randomized to either: (a) the Happy Older People are Engaged (HOPE) health promotion intervention (n=90) or (b) psychoeducation control (n=90). Assessment of cardiovascular risk, mental health, and HIV-related outcomes will be obtained at baseline, post intervention, 6-, and 12-months post intervention. The study has three specific aims: (1) to compare the efficacy of HOPE and the psychoeducation control in reducing cardiovascular risk among older adults with HIV with documented risk of cardiovascular disease; (2) to compare the efficacy of HOPE and the psychoeducation control in improving mental health and HIV-related outcomes in older adults with HIV; and (3) to examine mediators whereby HOPE reduces cardiovascular risk and improves mental health and HIV-related outcomes. Aims 1 and 2 will be tested separately using a Generalized Linear Mixed Model for main effects of group, time, and time-by-treatment interaction as the primary analytic strategy. For Aim 3, SEM will be applied to test mediation. As an exploratory aim, our team will explore CHW and decisionmaker perspectives on potential operational barriers and facilitators to the future implementation and dissemination of HOPE. Such data will yield useful information regarding future implementation of HOPE and related health promotion interventions. The proposed study will increase our understanding of the impact of HIV on older adults and has the potential to improve approaches for managing HIV-related comorbidities.