The overall objective of this K23 Career Development Award is to support the training and mentorship
necessary for Dr. Wise to transition to an independent investigator and enable her to build and sustain a
program of research developing, implementing, and testing behavioral interventions to reduce cardiovascular
disease (CVD) risk among women living with HIV (WLHIV). Completion of the proposed research and training
aims will enable Dr. Wise to gain the critical skillsets necessary to transition to independence and generate the
data necessary to support an R01 at the end of this award period. CVD is the number one cause of morbidity
and mortality among women in the United States (US). WLHIV have 2-4-fold higher risk for CVD compared to
women without HIV-infection. HIV and CVD disparities are particularly prevalent among women in the
Southern US. While increased prevalence of traditional risk factors (e.g., hypertension, diabetes, and obesity)
partially explain this risk, evidence suggests that increased exposure to adverse structural and social stressors
(i.e., poverty, discrimination, and stigma) among WLHIV in the South negatively contribute to CVD disparities
through their impact on stress. Stress is an established risk factor for CVD. WLHIV have 4-5x increased risk for
stress and stress-related disorders compared to the general population. While exposure to structural and social
stressors is difficult to change, behavioral interventions to reduce an individual’s stress response are
effective in reducing stress and may mitigate CVD risk. The Stress Management and Resiliency Training
(SMART) Intervention is an evidence based behavioral intervention offered as an integral part of
Massachusetts General Hospital’s Intensive Cardiac Rehabilitation program. The SMART intervention is
proven to reduce physiologic responses to stress. The intervention works to decrease stress responses and
CVD risk by improving resiliency to environmental stressors and decreasing sympathetic nervous system
activation. While the SMART intervention has demonstrated efficacy in a wide range of populations and
settings, it has not been designed or tested among WLHIV in the South, where unique cultural and faith-based
context may diminish the uptake and value of the intervention to mitigate CVD risk. To that end, the
overarching goal of this proposal is to develop the critical skillsets necessary to build a program of research
focused on developing, testing, and implementing behavioral interventions to reduce CVD risk. With the help of
my mentors, I will develop critical skillsets in 1) stress and CVD and interventions to reduce risk, 2) the
adaptation of interventions to maximize feasibility, acceptability, and impact, and the 3) design and conduct of
behavioral-implementation trials as we systematically adapt, implement, and pilot test the SMART
intervention for WLHIV in the Southern US. Data generated on the feasibility, acceptability, and preliminary
impact of the adapted intervention to reduce stress and mitigate CVD risk will directly support the development
of an R01 application to test the efficacy of the adapted SMART intervention at the end of this award period.