A cardiovascular disease risk reduction intervention that leverages the human animal bond to improve hypertension control among aging people living with HIV

About This Grant

Abstract Older people living with HIV (PLWH) face a new epidemic of uncontrolled hypertension (HTN), the leading risk factor for death and cardiovascular disease (CVD). This risk is further amplified by the frequent co-occurrence of social isolation, loneliness, poverty and sedentary lifestyles among older PLWH. Dog ownership is common among older PLWH and has the potential to improve HTN and CVD through increased social support, physical activity, and stress reduction provided by the human-animal bond: a mutually beneficial relationship between people and pets that influences health and well-being. Dogs are a particularly important source of support for older PLWH who disproportionately experience stigma, isolation, and psychosocial stress. Given the salience of human-animal bond in this population, there is a unique opportunity to leverage the benefits of companionship and physical activity inherent in dog ownership and improve the social, emotional and physical health among low-income, older, PLWH. We propose to adapt a community health worker (CHW)-delivered HTN intervention, the With Every Heartbeat is Life program, by harnessing the human-animal bond to improve HTN control. With Every Heartbeat is Life is an evidence-based intervention from the National Heart, Lung, and Blood Institute designed for resource-limited populations and includes CHW-led group sessions focused on lifestyle modification, medication adherence, and resource connection to improve CVD and HTN outcomes. Adapting this program to harness the human-animal bond to support behavior change that addresses the physical, social and economic needs of older PLWH is a highly innovative approach that has the potential to maximize HTN impacts. In this 2-year study, we will use implementation science methods to adapt and pilot test the adapted intervention. In Aim 1, we will collect robust qualitative data from key stakeholders to identify perspectives, facilitators and barriers of strategies that leverage the human-animal bond for HTN control. In Aim 2, we will convene an Intervention Design Team to iteratively adapt With Every Heartbeat is Life for low-income, older PLWH by harnessing the human-animal bond to promote healthy behaviors and HTN care engagement. In Aim 3, we will conduct a pilot randomized controlled trial (RCT) with 40 low-income, older PLWH who own dogs, randomized to the adapted intervention (n=20) or control group with general HTN education alone (n=20). We will assess intervention feasibility, fidelity and acceptability, examine preliminary effects on HTN control and CVD risk, and estimate effect sizes to inform a subsequent large-scale, trial in the U.S. South. This project will lay the groundwork for an R01 application to evaluate implementation, effectiveness, and scalability of the adapted intervention in a fully powered RCT and significantly improve HTN outcomes among aging PLWH in the U.S. South, a region with the highest co-occurring burden of HIV and CVD risk.