Monthly Archives: August 2015

The primary purpose of this article is to provide a broad overview of the research on the long-term effects of childhood risk factors on cardiovascular diseases (CVDs) during adulthood and to outline recommendations for prevention of CVDs based on evidence-based interventions (EBIs). CVDs are the leading cause of death and a major cause of disability in the United States and globally. Risk factors for CVDs are already identifiable in children and youth, and include both modifiable factors (e.g., unhealthy diet, physical inactivity, tobacco smoking), and factors that cannot be changed (e.g., age, heredity, sex). A fundamental issue has been the severity of the long-term effects of childhood risk factors (i.e., behavioral and intermediate risk factors) on subsequent cardiovascular health. It is clear from the empirical evidence that risk factors for CVDs can develop during childhood and adolescence. These risk factors in childhood have been linked to adverse health outcomes, including CVDs, during adulthood. The findings thus far suggest that, in order to be effective and reduce the risk of adulthood CVDs, intervention strategies should begin during childhood. The findings also underscore the importance of adopting a healthy lifestyle as early in life as possible.

Background: Real-world clinical settings like addiction treatment programs are ill-equipped to deploy and sustain the existing resource-demanding evidence-based interventions (EBIs) that target HIV-infected people who use drugs (PWUDs), and this has left a critical void in current HIV prevention efforts. In response to this unmet need, we have conducted formative research in addiction treatment settings that has resulted in Holistic Health for HIV (3H +) — an empirically adapted, substantially abbreviated version of Holistic Health Recovery Program (HHRP +), a CDC-recommended EBI targeting HIV-infected PWUDs.

Methods: Using a non-inferiority randomized controlled trial design, we will determine whether the abbreviated 3H + intervention is comparable (i.e., within a 10% margin) and cost-effective relative to the original HHRP + intervention in terms of reducing HIV risk behaviors and improving antiretroviral therapy (ART) adherence among HIV-infected PWUDs in addiction treatment who report drug- or sex-related HIV risk behaviors.

Conclusions: This article provides a description of the development and adaptation of the 3H + intervention, the innovative non-inferiority comparative experimental design for testing the 3H + to the HHRP +. Furthermore, it provides empirical evidence from a formal cost-effectiveness analysis justifying the cost-effectiveness of the 3H + intervention when compared to the HHRP + intervention. If confirmed to be comparable and more cost-effective, as hypothesized, the 3H + intervention has the potential to be readily and immediately integrated within common clinical settings where large numbers of HIV-infected PWUDs receive clinical services.