Adapting and Piloting a Stress Management Intervention to Reduce Cardiovascular Disease Risk among Women Living with HIV - 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 social stressors 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 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.
