ArticleJournal of general internal medicine2026
Translating the ABCSs into HIV Care: A Stepped Wedge Cluster Randomized Clinical Trial.
Article in Journal of general internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05488795 (Identifying Successful Strategies for Implementing Team-Based Home Blood Pressure Monitoring in Primary Care), which is not on this map. Not yet cited in PubMed.
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Identifying Successful Strategies for Implementing Team-Based Home Blood Pressure Monitoring in Primary Care
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14 authors.
Funding
Abstract
backgroundPeople living with HIV (PLWH) experience higher atherosclerotic cardiovascular disease (ASCVD) risk and events than people living without HIV.
objectiveWe evaluated a multilevel strategy, "Million Hearts," based on appropriate daily low-dose aspirin (A) use, blood pressure management (B), cholesterol (C) reduction with a statin, and smoking (S) cessation ("ABCS") on estimated 10-year ASCVD risk among PLWH.
designStepped-wedge cluster randomized clinical trial (SW-CRCT) involved nine practices caring for PLWH between 2019 and 2022.
participantsWithin participating sites of randomized wedges, we consented and enrolled 485 PLWH ages 40-75 with a 10-year baseline ASCVD risk ≥ 5% clustered within their consented treating clinician.
interventionPatient-directed interventions included (1) patient coaching on ASCVD risk and patient goal-setting selection of ABCS and (2) automated bidirectional texting to reinforce selected ABCS. Clinician-directed interventions included (1) academic detailing on ABCS and (2) feedback on patient risk and ABCS adoption. MAIN MEASURES: Ten-year ASCVD risk (primary outcome) and HIV viral load suppression (primary safety outcome). KEY
resultsThe intervention spanned the time of peak COVID-19 closures and reduced access for many health systems, and delayed intervention startup. While analysis based on the initially assigned start dates revealed no statistically significant effect on ASCVD risk, analysis based on actual start dates resulting from the COVID-19 pandemic showed a statistically significant reduction in ASCVD risk of -0.47 (95% CI -0.93 to -0.01) without evidence of any worsening of viral suppression (p = 0.6). This effect was driven by statistically significant reductions in cholesterol and smoking.
conclusionWhile delayed by COVID, the multicomponent intervention delivered based on actual start dates yielded statistically significant reductions in ASCVD risk among PLWH without increasing detectable viral load.
trial registrationNCT05488795; April 1, 2019.
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