Hyperlipidemia and Primary Prevention of Cardiovascular Disease Among Persons Living with HIV in East Africa

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Persons living with HIV (PLWH) are twice as likely to develop cardiovascular disease (CVD), and this excess risk persists despite viral suppression with antiretroviral therapy (ART). In the past 20 years, the global burden of CVD in PLWH has tripled, accounting for significant disease burden. Dyslipidemia is one mechanism by which HIV infection is associated with atherosclerotic CVD (ASCVD), partly due to side effects of ART. In this proposal, we plan to leverage the extensive experience of the SEARCH-Sapphire team in conducting implementation science research related to HIV care in Uganda in order to study hyperlipidemia and its association with HIV infection, which will lay the groundwork for future innovative strategies for integrating primary prevention of CVD into HIV care. In Aim 1, we will assess differences in hyperlipidemia, lipid screening, and statin eligibility by HIV status. In Aim 2, we will identify barriers and facilitators to the diagnosis and treatment of hyperlipidemia in the context of HIV. For Aim 1, the outcomes will be (1) total cholesterol levels, (2) proportion of patients with prior lipid testing, and (3) proportion of patients indicated for treatment with statin by the American College of Cardiology/American Heart Association (ACC/AHA) ASCVD risk calculator. We will use t-tests and chi-squared tests (or non-parametric tests if indicated) to compare outcomes by HIV status and linear and logistic regression models to account for covariates. For Aim 2, we will conduct semi-structured interviews with medical providers to identify barriers and facilitators to diagnosis and treatment of hyperlipidemia. Our qualitative analysis will be informed by the Consolidated Framework For Implementation Research (CFIR). The proposed study will provide critical preliminary data to inform the development of interventions to improve the diagnosis and treatment of hyperlipidemia among PLWH in Uganda.