PROJECT SUMMARY Hypertension is the most common comorbidity with HIV affecting over two thirds of women with HIV over forty years of age. Hypertension is a prominent risk factor for cardiovascular disease (CVD) that is modifiable through lifestyle behavior changes such as physical activity. On average, women with HIV engage in low levels of physical activity particularly if they reside in the southeastern United States where CVD risk is substantial. There are gaps in knowledge regarding the integration of lifestyle medicine approaches in HIV primary care. Further, under-representation and low engagement are significant barriers to existing behavioral physical activity interventions for women with HIV. The goal of the proposed Mentored Patient-Oriented Research Career Development Award (K23) is to provide the essential training and professional scaffolding critical for Dr. Crockett's career transition to independent clinical scientist focused on preventing and addressing cardiovascular comorbidities in underserved populations. To achieve this goal Dr. Crockett will pursue formal training in hypertension and cardiovascular health outcomes, advanced mixed methods research, adaptation of behavioral health interventions, and intervention science. These training aims will be accomplished through the wealth of institutional resources at the University of Alabama at Birmingham; close mentorship from experts; formal training through courses and intensive workshops; attendance at local, national, and international meetings; and professional development activities. This training will be applied to a research project that aims to: (1) elucidate the barriers and facilitators to daily physical activity behavior among women with HIV and hypertension using a social cognitive theory framework; (2) systematically adapt a prescriptive physical activity intervention with peer support for women with HIV and hypertension; and (3) conduct a pilot clinical trial of the adapted intervention to evaluate its acceptability, feasibility, and preliminary impact on systolic and diastolic blood pressure. The research aims will be accomplished by conducting a mixed methods assessment of daily physical activity behavior through objective measurement with accelerometers and experience sampling with 30 women with HIV and hypertension; using an evidence-based intervention adaptation framework (the “ADAPT-ITT model”) with input from key stakeholders (i.e., women with HIV, healthcare workers) in focus groups, expert consultations, and integration of the existing literature; and a randomized pilot intervention trial with 50 women with HIV and hypertension. Results of the proposed study will form the foundation for an NIH R01 application to evaluate the adapted intervention in a larger scale randomized controlled trial. The complimentary training and research goals will ensure Dr. Crockett's transition to independent clinical investigator and contribute to reducing the burden of CVD whi...