# A nurse-led intervention to extend the Veteran HIV treatment cascade for cardiovascular disease prevention (V-EXTRA-CVD)

> **NIH VA I01** · DURHAM VA MEDICAL CENTER · 2020 · —

## Abstract

Background: The VA is the largest provider of HIV care in the United States. The ~31,000 Veterans with HIV
use significantly more healthcare and have up to 2x higher risk of atherosclerotic cardiovascular disease
(ASCVD) compared to uninfected Veterans. The HIV treatment cascade model includes care steps; once
people obtain remission, providers should focus on preventing ASCVD. We will extend the HIV treatment
cascade and focus on reducing ASCVD risk among people with HIV. Veterans with HIV have low perceived
risk for ASCVD and uptake of guideline-based treatment for BP is low.
Significance/Impact: The proposed intervention has the potential to reduce ASCVD events in this population
by more than a quarter and meet VA strategic priorities of: 1) improve timeliness of services; 2) focus
resources more efficiently as well as address HSR&D research priorities: 1) patient centered care, care
management, and health promotion; 2) healthcare access; 3) aging; 4) virtual care.
Innovation: The study is innovative: Cascade Model. By leveraging the HIV treatment cascade model, we will
create a pathway for ASCVD risk reduction to be added into widespread quality improvement initiatives.
Stakeholder-engaged design process. We will employ stakeholder-engaged research methods to ensure the
intervention meets the needs of patients and healthcare providers. Multi-component nurse-led intervention.
While each of the components of our intervention have an evidence base, they have not been tested together
in an HIV context. Telehealth. We will use VA Video Connect (VVC) to monitor CVD risk factors.
Specific Aims: Aim 1a: Conduct qualitative interviews with Veterans and healthcare providers to ascertain
perceptions regarding HIV and CVD risk reductions to inform intervention adaptation.
Aim 1b: Adapt the intervention to the VA HIV clinic context with key stakeholder input.
Aim 2: Evaluate the 12-month efficacy of a nurse intervention to improve systolic blood pressure in Veterans
with HIV. Hypothesis: We hypothesize that our intervention will result in a clinically significant 6mmHg
reduction in SBP over 12 months compared to those receiving [enhanced education + usual care] only. Aim 3:
Conduct an evaluation of the prevention nurse intervention. Exploratory aim: If effective, [we will conduct a
budget impact analysis] and simulate 10-year cost-effectiveness of the nurse intervention.
Methodology: We will conduct qualitative interviews with care team and Veterans to adapt the intervention in
an iterative design process. We will then conduct a RCT to evaluate an intervention to reduce ASCVD risk. The
study will be conducted in 3 clinics among HIV+ veterans (n=300) on suppressive ART with confirmed SBP
>140 mmHg, stratified by clinic site and randomized 1:1 to intervention vs. education control. The intervention
will involve 4 evidence-based components based on our prior studies and adapted to veterans with HIV: (1)
nurse-led care coordination, (2) nurse-managed medicati...

## Key facts

- **NIH application ID:** 10064162
- **Project number:** 1I01HX003136-01A1
- **Recipient organization:** DURHAM VA MEDICAL CENTER
- **Principal Investigator:** Hayden B Bosworth
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-09-01 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10064162

## Citation

> US National Institutes of Health, RePORTER application 10064162, A nurse-led intervention to extend the Veteran HIV treatment cascade for cardiovascular disease prevention (V-EXTRA-CVD) (1I01HX003136-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10064162. Licensed CC0.

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