To date, there have been very few studies focused on the implementation, scale-up, and maintenance of delivering new interventions to communities where they are needed, and even fewer studies focused on underserved high-need communities. To address this gap, the NHLBI launched the Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) program and awarded the first projects in September 2020.
Seven DECIPHeR grantees in different areas of the country will begin working with local communities to evaluate a variety of proven interventions for conditions such as asthma, cardiovascular disease (CVD), and hypertension. For example:
The implementation science program also supports research to address global health disparities, including an effort to address HIV/AIDS and associated chronic diseases. The emergence of effective antiretroviral therapy for HIV has led to a decline in deaths from AIDS worldwide, but as people with HIV age, they are at higher risk than their peers for chronic heart, lung, blood, and sleep disorders. The NHLBI is supporting the development of model programs that can deliver proven prevention and treatments for chronic diseases associated with HIV among patients in low-resource settings in Africa. The program is funding projects in five African countries and a coordinating center in the United States.
Another implementation research effort is focused on improving diagnosis of a common genetic disorder called familial hypercholesterolemia (FH). FH can cause lifelong high levels of LDL (bad) cholesterol and lead to premature heart disease. It is estimated that less than 10 percent of people with FH have been diagnosed, and of those, only half are on life-saving therapies.
Screening family members of people with an FH diagnosis (called cascade screening) has proven effective at identifying undiagnosed patients, but it is often limited in reach due to patient privacy laws and lack of availability of FH genetic testing in some areas. In 2019, the NHLBI released a new funding opportunity to develop solutions to these barriers, with applications due in March 2021.