# Behavioral Economics and Implementation Research to Reduce Cardiovascular Risk in HIV-infected Adults

> **NIH NIH U01** · UNIVERSITY OF CALIFORNIA LOS ANGELES · 2020 · $671,825

## Abstract

ABSTRACT
Cardiovascular disease (CVD) is a major cause of morbidity among people living with HIV
(PLWH). Evidence-based statin therapy is highly effective at reducing cardiovascular risk but is under-
prescribed for PLWH due to provider- and patient-level barriers. Potential provider-level barriers include
misconceptions about potential side effects, inadequate knowledge of guideline recommendations, and
concerns about patient adherence. Patient-level barriers to new prescription uptake often relate to concerns
about side effects and uncertainty about benefits. Implementation science research suggests that barriers to
implementation of evidence-based practices can occur at all levels of an organization, including at the
leadership, provider, and patient levels, and that barriers at each level must be addressed for successful
implementation to occur. We, therefore, propose a multi-level intervention to increase evidence-based statin
prescribing by addressing barriers at these levels using the Consolidated Framework for Implementation
Research. Following a qualitative phase to inform and tailor the intervention's educational component, we will
implement (1) tailored education at the leadership, provider, and patient levels, and (2) provider peer
comparisons. To educate leadership, specifically medical directors, we will provide a brief, in-person “peer
champion”-led educational module about CVD risk in PLWH and evidence-based statin use. Patients will
receive pamphlets about CVD and communication strategies with providers. A behavioral economics peer
comparison strategy, to be implemented six months after the first intervention component, will be email-
based and compare each physician's rate of provision of statin therapy relative to top-performing physicians
caring for PLWH. In partnership with the Los Angeles County Ambulatory Care Network and community
clinics (N=11 clinics), we will use a stepped-wedge cluster randomized trial design to pursue these aims: Aim
1: Assess knowledge about and barriers to statin prescribing among clinic leadership, providers, and PLWH
and adapt the intervention's education intervention to address barriers at each level. Aims 2a and 2b:
Determine effectiveness of the (2a) education intervention and (2b) peer comparison intervention on adoption
(outcome is providers' prescribing rates) of evidence-based statin therapy. Aims 3a, 3b, and 3c: Assess
implementation outcomes, including (3a) changes in provider acceptability of statin prescribing for PLWH; (3b)
provider acceptability of the education and peer comparison interventions; and (3c) cost of implementing the
education and peer comparison.

## Key facts

- **NIH application ID:** 9978910
- **Project number:** 5U01HL142104-03
- **Recipient organization:** UNIVERSITY OF CALIFORNIA LOS ANGELES
- **Principal Investigator:** Joseph Abiodun Ladapo
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $671,825
- **Award type:** 5
- **Project period:** 2018-06-01 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9978910

## Citation

> US National Institutes of Health, RePORTER application 9978910, Behavioral Economics and Implementation Research to Reduce Cardiovascular Risk in HIV-infected Adults (5U01HL142104-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9978910. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*