Project Grant R21HL184902

PORTABLE ECHO FOR AGING HEARTS: ASSESSING CARDIAC HEALTH IN OLDER ADULTS WITH HIV - ABSTRACT IN TANZANIA, OVER 1.5 MILLION PEOPLE ARE LIVING WITH HIV (PLH). WITH IMPROVEMENTS IN ACCESS TO EFFECTIVE ART, THE NUMBER OF PLH SURVIVING INTO OLDER AGE HAS INCREASED SUBSTANTIALLY. CURRENTLY, 30% OF PLH IN TANZANIA ARE AGED 50 YEARS AND OLDER, WITH THIS POPULATION EXPECTED TO INCREASE BY 25% BY 2040. AGEING PLH FACE A SIGNIFICANT BURDEN OF CARDIOVASCULAR DISEASE (CVD) DUE TO A COMBINATION OF TRADITIONAL RISK FACTORS, HIV ASSOCIATED INFLAMMATION, AND IMMUNE DYSFUNCTION. HEART FAILURE IS ONE OF THE LEADING CAUSES OF CARDIAC DISEASE IN ADULTS IN TANZANIA, WITH HYPERTENSION ACCOUNTING FOR ABOUT HALF OF ALL CASES. CARDIAC ECHOCARDIOGRAPHY IS A VALUABLE, NON-INVASIVE TOOL FOR DETECTING STRUCTURAL AND FUNCTIONAL ABNORMALITIES ASSOCIATED WITH HEART FAILURE, INCLUDING LEFT VENTRICULAR DYSFUNCTION, VALVULAR DISEASE, AND DIASTOLIC IMPAIRMENT. HOWEVER, ACCESS IS LIMITED IN RESOURCE CONSTRAINED SETTINGS LIKE TANZANIA AND AS A RESULT DIAGNOSES ARE OFTEN MADE VERY LATE. POINT-OF-CARE CARDIAC ULTRASOUND (POCUS) OFFERS A POTENTIALLY SCALABLE SOLUTION FOR CARDIOVASCULAR SCREENING IN AGEING PLH IN HIV CLINICS AND EARLY DETECTION OF CARDIAC ABNORMALITIES THAT COULD LEAD TO HEART FAILURE. THIS R21 EXPLORATORY/DEVELOPMENTAL GRANT PROPOSES TO ASSESS THE CLINICAL UTILITY, FEASIBILITY AND IMPACT OF IMPLEMENTING AI-POCUS FOR EARLY DETECTION OF CARDIAC DYSFUNCTION IN AGING PLH IN TANZANIA. 400 PLH EQUAL TO OR GREATER THAN 50 YEARS ENROLLED IN THE TANZANIA HIV AGEING LONGITUDINAL COHORT STUDY (THALCS), A MULTISITE OBSERVATIONAL COHORT STUDY OF AGEING OUTCOMES AND QUALITY OF LIFE, WILL UNDERGO A FOCUSED AI-POCUS ASSESSMENT USING THE BUTTERFLY IQ3 PORTABLE AI-DRIVEN ULTRASOUND SYSTEM, PERFORMED BY TRAINED NON-SPECIALIST PROVIDERS (HCP) AT THALCS STUDY SITES. SPECIFICALLY, WE WILL (1) EVALUATE THE UTILITY OF POCUS FOR IDENTIFYING KEY MARKERS OF CARDIAC DYSFUNCTION (E.G., LEFT VENTRICULAR HYPERTROPHY, SYSTOLIC/DIASTOLIC DYSFUNCTION, PERICARDIAL EFFUSION) AND NEED FOR CARDIOLOGY REFERRAL; AND (2) ASSESS THE FEASIBILITY AND ACCEPTABILITY OF AI-POCUS AMONG HEALTHCARE PROVIDERS AND PARTICIPANTS AND THE CLINICAL IMPACT OF AI-POCUS ON SHORT TERM (12 MONTH) PARTICIPANT OUTCOMES. THE PROPOSED WORK ALSO HAS DIRECT RELEVANCE TO THE UNITED STATES, WHERE MORE THAN HALF OF PLH IN CARE ARE NOW AGED 50 YEARS AND OLDER AND EXPERIENCE DISPROPORTIONATELY HIGH RATES OF HYPERTENSION, HEART FAILURE, AND OTHER CARDIOVASCULAR COMPLICATIONS. FINDINGS FROM THIS STUDY MAY INFORM SCALABLE, TASK-SHIFTED APPROACHES FOR INTEGRATING AI-ASSISTED CARDIAC SCREENING INTO HIV PRIMARY CARE SETTINGS IN THE US, INCLUDING FEDERALLY QUALIFIED HEALTH CENTERS AND RURAL CLINICS WITH LIMITED ACCESS TO CARDIOLOGY AND ECHOCARDIOGRAPHY SERVICES. THIS PROJECT WILL GENERATE CRITICAL PILOT DATA TO INFORM SCALABLE STRATEGIES FOR CVD SCREENING IN AGING PLWH AND LAY THE GROUNDWORK FOR FUTURE TRIALS OF POCUS-GUIDED INTERVENTIONS. ULTIMATELY, IT SEEKS TO REDUCE CARDIOVASCULAR MORBIDITY AND IMPROVE QUALITY OF LIFE IN A VULNERABLE AND GROWING POPULATION.