INcreasing Statin Prescribing in HIV Behavioral Economics REsearch

NCT ID: NCT03687060

Last Updated: 2023-10-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

75 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-03-04

Study Completion Date

2024-03-31

Brief Summary

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Cardiovascular disease is a major cause of morbidity and mortality among people living with HIV. Recent studies have demonstrated that patients with HIV experience a 50-100% increased risk of myocardial infarction and stroke compared to HIV-uninfected persons. They also face higher risks of stroke, sudden death, and heart failure. However, evidence-based statin therapy-which is safe in this population and highly effective at reducing cardiovascular risk-is under-prescribed. The investigators propose a multi-level intervention to increase evidence-based statin prescribing by addressing barriers at these levels. The implementation intervention includes two strategies: (1) tailored education at the leadership, provider, and patient levels, and (2) behavioral economics-informed feedback for providers.

Detailed Description

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Conditions

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HIV Cardiovascular Diseases

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Stepped-wedge cluster randomized trial
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Organization Level

Group Type OTHER

Knowledge assessment

Intervention Type BEHAVIORAL

Investigators will conduct semi-structured interviews with medical directors, clinical leadership and all participating physicians to gain insight on knowledge about and barriers to prescribing statins for people living with HIV. People living with HIV will participate in focus groups.

Provider Level

Group Type OTHER

Knowledge assessment

Intervention Type BEHAVIORAL

Investigators will conduct semi-structured interviews with medical directors, clinical leadership and all participating physicians to gain insight on knowledge about and barriers to prescribing statins for people living with HIV. People living with HIV will participate in focus groups.

Education Intervention

Intervention Type BEHAVIORAL

Education intervention will be adapted from the the findings of these interviews and focus groups.

Clinics will be randomized to receive the "education intervention and feedback" implementation strategies at different times.

Medical directors and providers will receive a brief educational intervention about cardiovascular disease risk in people living with HIV. Providers will additionally receive a web-based survey before and after the education intervention.

Patients will receive pamphlets tailored to the effects of cardiovascular disease treatment for people living with HIV.

Provider Feedback

Intervention Type BEHAVIORAL

Six months after the education intervention, providers will receive monthly emails with feedback regarding their rates of prescribing statins, with language targeted at increasing motivation to prescribe by leveraging social norms and self-image.

Patient Level

Group Type OTHER

Knowledge assessment

Intervention Type BEHAVIORAL

Investigators will conduct semi-structured interviews with medical directors, clinical leadership and all participating physicians to gain insight on knowledge about and barriers to prescribing statins for people living with HIV. People living with HIV will participate in focus groups.

Interventions

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Knowledge assessment

Investigators will conduct semi-structured interviews with medical directors, clinical leadership and all participating physicians to gain insight on knowledge about and barriers to prescribing statins for people living with HIV. People living with HIV will participate in focus groups.

Intervention Type BEHAVIORAL

Education Intervention

Education intervention will be adapted from the the findings of these interviews and focus groups.

Clinics will be randomized to receive the "education intervention and feedback" implementation strategies at different times.

Medical directors and providers will receive a brief educational intervention about cardiovascular disease risk in people living with HIV. Providers will additionally receive a web-based survey before and after the education intervention.

Patients will receive pamphlets tailored to the effects of cardiovascular disease treatment for people living with HIV.

Intervention Type BEHAVIORAL

Provider Feedback

Six months after the education intervention, providers will receive monthly emails with feedback regarding their rates of prescribing statins, with language targeted at increasing motivation to prescribe by leveraging social norms and self-image.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* age ≥ 40 years
* have been diagnosed with HIV
* LDL ≥ 190, diabetes and LDL ≥ 70
* or 10-year ASCVD risk ≥ 7.5%
* or history of heart attack, stroke, or peripheral vascular disease
* care for patients with HIV at least 1/2 day each week (physicians)
* work at participating clinics (physicians)

Exclusion Criteria

* unable to provide written, informed consent
* not at participating clinic
Minimum Eligible Age

40 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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RAND

OTHER

Sponsor Role collaborator

Olive View-UCLA Education & Research Institute

OTHER

Sponsor Role collaborator

University of California, Los Angeles

OTHER

Sponsor Role lead

Responsible Party

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Allison L. Diamant

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Allison Diamant, MD, MSHS

Role: PRINCIPAL_INVESTIGATOR

University of California, Los Angeles

William Cunningham, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of California, Los Angeles

Locations

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JWCH Institute

Commerce, California, United States

Site Status

Antelope Valley Health Center

Lancaster, California, United States

Site Status

Watts Health Center

Los Angeles, California, United States

Site Status

Oasis Clinic

Los Angeles, California, United States

Site Status

To Help Everyone Health and Wellness Centers

Los Angeles, California, United States

Site Status

Venice Family Clinic

Santa Monica, California, United States

Site Status

Olive View-UCLA Medical Center

Sylmar, California, United States

Site Status

Tarzana Treatment Centers, Inc.

Tarzana, California, United States

Site Status

Countries

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United States

References

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Feinstein MJ, Bahiru E, Achenbach C, Longenecker CT, Hsue P, So-Armah K, Freiberg MS, Lloyd-Jones DM. Patterns of Cardiovascular Mortality for HIV-Infected Adults in the United States: 1999 to 2013. Am J Cardiol. 2016 Jan 15;117(2):214-20. doi: 10.1016/j.amjcard.2015.10.030. Epub 2015 Nov 6.

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Thompson-Paul AM, Lichtenstein KA, Armon C, Palella FJ Jr, Skarbinski J, Chmiel JS, Hart R, Wei SC, Loustalot F, Brooks JT, Buchacz K. Cardiovascular Disease Risk Prediction in the HIV Outpatient Study. Clin Infect Dis. 2016 Dec 1;63(11):1508-1516. doi: 10.1093/cid/ciw615. Epub 2016 Sep 9.

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Cohen JD, Brinton EA, Ito MK, Jacobson TA. Understanding Statin Use in America and Gaps in Patient Education (USAGE): an internet-based survey of 10,138 current and former statin users. J Clin Lipidol. 2012 May-Jun;6(3):208-15. doi: 10.1016/j.jacl.2012.03.003.

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Wei MY, Ito MK, Cohen JD, Brinton EA, Jacobson TA. Predictors of statin adherence, switching, and discontinuation in the USAGE survey: understanding the use of statins in America and gaps in patient education. J Clin Lipidol. 2013 Sep-Oct;7(5):472-83. doi: 10.1016/j.jacl.2013.03.001. Epub 2013 Mar 13.

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Other Identifiers

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1U01HL142104-01

Identifier Type: NIH

Identifier Source: org_study_id

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