About

Hayden Barry Bosworth is a Professor in Population Health Sciences, Professor in Medicine, and Professor in Psychiatry and Behavioral Sciences at Duke University. He is also a Senior Fellow in the Center for the Study of Aging, an Associate of the Duke Initiative for Science & Society, a Member in the Duke Clinical Research Institute, and an Affiliate Faculty Member of the Duke-Margolis Institute for Health Policy. His roles indicate a focus on aging, health policy, and clinical research within the context of behavioral sciences and medicine, contributing to interdisciplinary efforts in these areas.

Research topics

• Medicine
• Computer Science
• Family medicine
• Nursing
• Internal medicine
• Medical emergency
• Political Science
• Psychology
• Emergency medicine
• Intensive care medicine
• Physical therapy
• Psychiatry
• Law
• Endocrinology
• Demography
• Clinical psychology

Selected publications

• Supplementary Table 1 from Association of Race and Ethnicity with Genomic Testing at a Comprehensive Cancer Center in North Carolina

  2026-03-16

  articleOpen access

  <p>Supplementary Tables S1a-S1d show estimates for the association between any genomic testing and race and ethnicity among non-Hispanic Black and non-Hispanic White patients by cancer type</p>

  PublisherDOI

• The Diabetes Staging System (DSS): A Pilot Study Assessing Feasibility, Provider Engagement and Implementation Challenges of a Novel Staging System for Type 2 Diabetes

  Diabetes Metabolic Syndrome and Obesity · 2026-04-01

  articleOpen accessSenior author

  Introduction and Objective: Type 2 diabetes (DM2) currently lacks a standardized staging system that can be used to predict survival and guide providers towards guideline concordant care much like TNM staging does for cancer. We conducted a pilot study to assess the feasibility, provider engagement and implementation challenges of the DSS and examined if guideline concordant care improved especially SGLT2i/GLP-1a use in Veterans DM2 patients with cardiorenal disease. Methods: A 6-month pilot study implemented DSS in VA primary care clinics between December 2023-September 2024. Study visits were at baseline and 6 months. Primary outcome: the initiation of SGLT2i/GLP-1a in Veteran DM2 patients with CVD/CKD compared to baseline. Secondary outcomes: weight, blood pressure, hemoglobin A1C, glomerular filtration rate (GFR), and medication adherence compared to baseline. Inclusion criteria: Male or female Veterans between the ages of 18-75 years with DM2 and ≥1 CV event and/or CKD and not on SGLT2i/GLP-1a. Exclusion criteria: Veterans with contraindications to SGLT2i/GLP-1 and/or a serious mental health disorder. Results: After baseline visit, all providers prescribed to 14/14 patients at least one of the medications with 12/14 prescribed SGLT2i and 2/14 prescribed GLP-1a. We found 13/14 (93%) patients to still be on at least one of the medications at 6 months. At 6 months compared to baseline, weight (216 lbs. ± 41 → 213 lbs. ± 39), blood pressure (141/76 ± 20/10 → 132/73 ± 17/10), A1C (7.7% ± 1.5% → 7.4% ± 0.8%) modestly decreased but GFR remained stable (64 mL/min ± 17 → 64 mL/min ± 19). Medication adherence was continued for all 13 patients (Medication possession ratio was ≥80%). Conclusion: DSS use was associated with increased SGLT2i/GLP-1a prescribing by VA primary care providers and medication adherence in Veterans DM2 patients with CVD/CKD. The DSS could help improve cardiorenal outcomes and guideline concordant in their DM2 patients in the future if larger studies can validate these findings. Clinical Trials Registration Number: NCT06142006.

  PublisherDOI

• Navigating the heat: implementation challenges and opportunities for heat alert communication and rural health data infrastructure

  Frontiers in Public Health · 2026-04-15

  articleOpen accessSenior author

  Extreme heat is the most significant climate threat to public health, disproportionately impacting marginalized groups, including outdoor workers, older adults, and low-income rural populations. While the physiological consequences of heat-related illness-ranging from cardiovascular strain to acute kidney injury-are well-documented, a critical gap remains in the equitable implementation of mitigation strategies. This paper examines North Carolina as a case study due to its proactive leadership in heat-health mitigation, examining the evolution of the state's Heat Health Alert System and the NC DETECT surveillance platform. North Carolina is well-positioned to pioneer a multi-modal "push" communication strategy, leveraging the ubiquity of smartphone technology and Wireless Emergency Alerts to provide "just-in-time" guidance to high-risk outdoor workers and rural residents. Simultaneously, the state can strengthen its robust surveillance infrastructure by integrating data from non-traditional care sites, such as farmworker clinics, and standardizing occupational data collection. These advancements would transform existing systems into a comprehensive, community-informed model of resilience. By expanding communication modalities and data inclusivity, North Carolina offers a scalable framework for translating meteorological risk into actionable, equitable policy-ensuring that advancements in climate preparedness protect and empower the most vulnerable populations.

  PublisherOA PDFDOI

• Patient and Clinician Perspectives on Chronic Pain Communication in Advanced Kidney Disease

  Journal of the American Geriatrics Society · 2026-04-15

  articleOpen access

  BACKGROUND: Chronic pain is highly prevalent among older adults with advanced chronic kidney disease (CKD stage 4, stage 5, and end-stage kidney disease [ESKD]). Yet, pain management involves a delicate balance between alleviating symptoms and avoiding harm related to impaired renal drug clearance and the high risk of medication side effects. Because little is known about how patients and clinicians navigate these complex pain management conversations, we examined patient and provider perspectives on communication and decision making in chronic pain and advanced kidney disease. METHODS: We conducted a qualitative study using semi-structured interviews based on the Ottawa Decision Support Framework. Participants included older adults (age ≥ 65) with both advanced CKD and chronic pain lasting ≥ 3 months and physicians and advanced practice providers from primary care, geriatrics, nephrology, and palliative care. We used thematic analysis to summarize major themes on communication and decision making. RESULTS: We interviewed 48 participants, including 24 older adults with advanced kidney disease and chronic pain and 24 clinicians, with 6 clinicians from each specialty. Three major themes about barriers to effective communication emerged: (1) treatment complexity and uncertainty; (2) fragmentation of care across specialties and the care team; and (3) divergent treatment preferences between patients and clinicians. Communication strategies to overcome these barriers included: open communication, multidisciplinary care team collaboration, patient advocacy, and relationship- and values-centered decision making. CONCLUSIONS: This study highlighted key barriers and potential communication strategies among older adults with chronic pain and advanced kidney disease. These findings can inform the development of targeted interventions that support patients and clinicians in navigating these complex conversations and decisions.

  PublisherOA PDFDOI

• Optimizing Antihypertensive Care for Tanzanians Living with HIV: Effectiveness Outcomes from the COACH Pilot Trial

  JAIDS Journal of Acquired Immune Deficiency Syndromes · 2026-03-31

  article

  Background: In Tanzania, many people living with HIV (PLWH) have uncontrolled hypertension, yet integration of hypertension management into HIV care remains limited. The Community Health Worker Optimization of Antihypertensive Care in HIV (COACH) intervention was developed to integrate standardized hypertension management into HIV clinic workflows. Setting: A single-arm pilot trial was conducted from December 2024 to September 2025 at two public HIV clinics in Moshi, Tanzania. Methods: COACH included six monthly community health worker (CHW)-delivered hypertension education sessions within HIV clinic visits, monthly blood pressure (BP) checks, care coordination, subsidized antihypertensive medications, a standardized treatment algorithm, and provider training. The primary effectiveness outcome was BP control at six months (<140/<90 mmHg). Secondary effectiveness outcomes included systolic and diastolic BP (SBP/DBP), hypertension knowledge (HK-LS score), medication adherence, BMI, and five-year cardiovascular risk. Paired t-tests and McNemar’s tests compared baseline and follow-up values. Results: Of 100 participants, 96 completed follow-up. Six-month BP control was achieved in 73 (76%). Mean SBP decreased from 159.6 mmHg at baseline to 130.8 mmHg at follow-up (-28.9 mmHg, p<0.001); DBP decreased from 100.8 to 85.5 mmHg (-15.4 mmHg, p<0.001). HK-LS scores increased from 15.0 to 20.4 (p<0.001), and self-reported adherence improved from 14.0% to 95.0% (p<0.001). Mean BMI decreased from 27.0 to 26.6 kg/m 2 (p=0.019), and the proportion with ≥20% five-year cardiovascular risk declined from 33% to 7% (p<0.001). Conclusions: COACH resulted in substantial improvements in BP control, hypertension knowledge, medication adherence, and cardiovascular risk among PLWH in Tanzania.

  PublisherDOI

• Racial and Ethnic Disparities in the Incidence and Prevalence of Low Back Pain in the United States: A Systematic Review

  Arthritis Care & Research · 2025-10-14

  review

  OBJECTIVE: This systematic review synthesizes existing evidence to quantify racial and ethnic disparities in low back pain (LBP) incidence and prevalence in the United States across stages of chronicity (acute, subacute, and chronic LBP). METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science (through January 7, 2025) for studies reporting LBP incidence or prevalence by race and ethnicity in US adults. Risk of bias was assessed using the Risk of Bias in Non-randomized Studies - of Exposure (ROBINS-E) tool. RESULTS: Of 8,145 citations, 23 studies met inclusion criteria (10 on incidence, 13 on prevalence). Some incidence studies found higher risk of chronic LBP among Black adults compared to White adults, whereas data on Hispanic and Latino adults remain limited. Prevalence studies showed higher rates in White and American Indian and Alaska Native adults, with lower prevalence in Black, Hispanic and Latino, and Asian adults. Military studies consistently reported that Black service members experienced higher LBP incidence compared to other races. No studies examined the subacute state. CONCLUSION: This review highlights persistent race-based differences in LBP, with critical gaps in research on acute LBP incidence and community-based prevalence. Future studies should prioritize population-based research to better capture racial differences in LBP burden and inform targeted interventions.

  PublisherDOI

• Abstract Sun903: Out-of-hospital cardiac arrest systems of care perspectives of initiating a drone as first responder automated external defibrillator program in counties within North Carolina and Virginia

  Circulation · 2025-11-03

  article

  Introduction: Bystander defibrillation remains low throughout the US (1-4%). The REciprocal InnovationS TO ImpRovE Cardiovascular CARE in Rural America (RESTORe-CARE) project is designed to develop and pilot a drone-delivered AED program in two counties. While partners may likely be supportive of a drone-delivered AED program, understanding differences in perceived challenges by organizational role may be critical to future adoption. Objectives: We sought to examine out-of-hospital systems of care perspectives and acceptability of the drone-delivered AED program to inform subsequent implementation. Methods: We developed a multiple methods survey informed by the Consolidated Framework for Implementation Research, which is a conceptual framework that guides the systematic assessment of implementation. Surveys were collected from Forsyth County, NC and James City, VA. We categorized partners by role (Emergency Medical Services (EMS), Sheriff/9-1-1, Medical/9-1-1, Fire/First Responders, and Other) and examined differences in responses by role and location. The survey data were analyzed using Pearson’s Chi-squared test. Qualitative data were reported by top salient themes. Results: From 4/2024-8/2024, 102 surveys were completed; 10% (EMS), 42% (Sheriff/9-1-1), 8% (Medical/9-1-1), 21% (Fire/Fire Responders), and 19% (Other). Experience with drones varied, with individuals expressing no experience with using drones and experience using drones in emergencies (Table 1). When queried about the extent implementing the drone program provided an advantage to their organization, responses varied by primary role (p=0.04; great extent: 22% EMS, 47% Sheriff, 50% Medical 911, 57% Fire, 18% Other) and location (p=0.01; great extent: 48% Forsyth County, 38% James City County). When asked about their expectation of drone-delivered AED program effectiveness, responses varied by primary role (p<0.01; Very effective/effective: 38% EMS, 41% Sheriff, 44% Medical 911, 68% Fire, 30% Other). Participants mentioned uncertainty in drone response times compared to those of traditional law enforcement units and concerns around insufficient staffing/resources and cost (Table 1). Conclusion: Perspectives of the drone-delivered AED intervention differed by organizational partner role. Understanding differences by role may inform future adoption of our developing drone-delivered AED program. This process may generalize to other innovative, emergent cardiac arrest interventions.

  PublisherDOI

• Mixed methods implementation research of oral antiviral treatment for COVID-19 in low- and middle-income countries: a study protocol

  BMJ Open · 2025-09-01

  articleOpen accessSenior author

  INTRODUCTION: There is an absence of real-world evidence, especially from low- and middle-income countries (LMICs), on the implementation successes and challenges of COVID-19 Test and Treat (T&T) programmes. In 2022, nirmatrelvir/ritonavir was provided as standard of care for mild to moderate COVID-19 treatment in eight LMICs (Ghana, Kenya, Laos, Malawi, Nigeria, Rwanda, Uganda and Zambia). This manuscript describes a research protocol to study novel drug introduction during the COVID-19 health emergency, with implications and learnings for future pandemic preparedness. The goal of the study is to provide simultaneous programme learnings and improvements with programme rollout, to fill a gap in real-world implementation data on T&T programmes of oral antiviral treatment for COVID-19 and inform programme implementation and scale-up in other LMICs. METHODS AND ANALYSIS: This multiple methods implementation research study is divided into three components to address key operational research objectives: (1) programme learnings, monitoring and evaluation; (2) patient-level programme impact; and (3) key stakeholder perspectives. Data collection will occur for a minimum of 6 months in each country up to the end of grant. Quantitative data will be analysed using descriptive statistics for each country and then aggregated across the programme countries. Stakeholder perspectives will be examined using the Consolidated Framework for Implementation Research implementation science framework and semistructured interviews. ETHICS AND DISSEMINATION: This study was approved by the Duke University Institutional Review Board (Pro00111388). The study was also approved by the local institutional review boards in each country participating in individual-level data collection (objectives 2 and 3): Ghana, Malawi, Rwanda, Nigeria and Zambia. The study's findings will be published in peer-reviewed journals and disseminated through dialogue events, national and international conferences and through social media. TRIAL REGISTRATION NUMBER: NCT06360783.

  PublisherDOI

• Differences in guideline directed medical therapy for rural and non-rural Veterans with heart failure with reduced ejection fraction

  American Heart Journal · 2025-10-31

  article
  PublisherDOI

• Adapting an intervention to improve hypertension care for adults with HIV in Tanzania: Co-design of the Community Health Worker Optimization of Antihypertensive Care in HIV (COACH) intervention

  medRxiv · 2025-11-27

  preprintOpen access

  Abstract Introduction There is a large burden of uncontrolled hypertension among people with HIV (PWH) in sub-Saharan Africa (SSA), including in Tanzania. Yet, few evidence-based interventions to improve hypertension control have been adapted for use in PWH in this region. This study describes the adaptation process of an evidence-based hypertension intervention to develop the Community Health Worker Optimization of Antihypertensive Care in HIV ( COACH ) intervention, a multi-component strategy designed to improve blood pressure control among Tanzanians with HIV and hypertension. Methods A 27 member interdisciplinary intervention design team consisting of HIV and hypertension clinicians, nurses, community health workers (CHWs), pharmacists, social workers and patients with HIV and hypertension from Tanzania met biweekly from May 2024 to October 2024. The design team used the Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) framework supported by participatory co-design principles to iteratively adapt the intervention to the local context. Results To address the unique needs of PWH and hypertension in Tanzania, we iteratively adapted an evidence-based CHW intervention for hypertension care originally developed in Asia ( Control of Blood Pressure and Risk Attenuation—COBRA ), resulting in development of the COACH intervention for the HIV clinical setting in Tanzania. COACH , includes five key components: 1) CHW-delivered hypertension counselling integrated into HIV clinic visits, 2) Integration of routine blood pressure monitoring and referrals for antihypertensive medication management in the HIV clinic, 3) Hypertension management training for HIV providers and creation of an antihypertensive treatment algorithm, 4) CHW care navigation and coordination of hypertension care in the HIV clinic, and 5) Subsidization of antihypertensive medications. Conclusions COACH is one of the first contextually-tailored interventions developed to address hypertension care among PWH in Tanzania. A pilot feasibility study of the intervention is in process and future studies will evaluate the implementation and clinical effectiveness outcomes of the COACH intervention. The rigorous, systematic application of the ADAPT-ITT framework to iteratively develop COACH supports reproducibility of the adaptation process, and strengthens the potential for COACH core components to be highly relevant for PWH with hypertension in other resource limited settings worldwide.

  PublisherOA PDFDOI

Recent grants

• NIH Grant R34DK102166

  NIH · $711k · 2018

• NIH Grant R01HL070713

  NIH · $3.7M · 2010

• NIH Grant R01DK093938

  NIH · $3.4M · 2019

• Dissemination and Implementation Science in Cardiovascular Outcomes (DISCO)

  NIH · $3.9M · 2017–2024

• HSR&D Senior Research Career Scientist Award

  NIH · 2020–2027

Frequent coauthors

• Gianfranco Parati

  University of Milano-Bicocca

  540 shared

• David J. Magid

  University of Colorado Denver

  540 shared

• Stefano Omboni

  Italian Institute of Telemedicine

  538 shared

• Ilkka Kantola

  537 shared

• Brian McKinstry

  University of Edinburgh

  536 shared

• Juha Varis

  Lappeenranta-Lahti University of Technology

  536 shared

• Karen L. Margolis

  HealthPartners

  536 shared

• Richard J. McManus

  University of Oxford

  536 shared

Education

• PhD, Human Development and Family Studies,

  Pennsylvania State University