Persons aging with HIV (PWH) are increasingly affected by preventable cancers and chronic diseases, which now account for the majority of morbidity and mortality in the era of effective antiretroviral therapy. Despite clear national guidelines, uptake of cancer and chronic disease screening remains persistently low among PWH, with evidence suggesting even greater gaps in community-based and non-academic HIV clinics. These deficits are driven by interrelated patient-, provider-, and system-level barriers, including fragmented care delivery, unclear role ownership, and structural barriers to follow-up. However, rigorous, framework-guided investigations of these barriers—and pragmatic strategies to address them within HIV specialty care—are lacking.
This DC CFAR Pilot project seeks to address these gaps by generating foundational pre-implementation evidence and co-designing a novel Integrated Preventive Care Visit (IPCV) model that embeds a primary care provider (PCP)– navigator dyad directly into existing HIV specialty care. In Aim 1, we will analyze DC Cohort data to quantify site- specific gaps in cancer (lung, breast, colorectal, cervical) and chronic disease (osteoporosis, abdominal aortic aneurysm, hyperlipidemia, diabetes) screening across academic, community-based, and private HIV clinics, and examine associations with HIV outcomes including viral suppression. In Aim 2, guided by the two implementation frameworks (EPIS and COM-B), we will conduct in-depth interviews with PWH and HIV care team members to identify multilevel barriers and facilitators to preventive screening, producing a DC-specific determinant matrix to guide intervention development.
In Aim 3, we will use human-centered design and co-design methods to collaboratively develop an implementation- ready IPCV model tailored to HIV clinic workflows and patient experiences. Through structured co-design workshops with PWH and clinic stakeholders, we will define IPCV workflows, clarify PCP and navigator roles, develop patient- facing communication tools and decision aids, and prototype a stand-alone preventive care dashboard consolidating guideline-directed screenings. These components will be iteratively refined to ensure feasibility, acceptability, and usability, resulting in a complete IPCV intervention package—including workflows, toolkits, dashboard specifications, and an implementation manual—ready for pilot testing. This project will produce the first systematically developed, patient-informed preventive care visit overlay model for PWH in Washington, DC, and directly inform a future NIH R01 hybrid implementation trial.
Project Summary provided by investigator.