Addressing barriers to anti-hypertensive medication adherence among persons living who have achieved viral suppression

摘要 在那些患有高血压的人中，艾滋病毒携带者(PWH)患心肌梗死的风险要高出50% 与普通人群相比，他们往往无法达到循证治疗目标 高血压。血压控制不足的一个重要因素是不坚持 抗高血压药物。对PWH用药依从性的研究主要集中在 坚持抗逆转录病毒治疗，仅限于坚持服用其他非艾滋病条件药物。 坚持服用降压药的主要决定因素是由以下因素共同驱动的 在患者、提供者和医疗保健系统级别运行。然而，目前还缺乏关于如何 利用这些级别的影响来影响遵守的发起、实施和管理 治疗PWH和高血压的抗高血压药物。那么，问题是我们如何调整证据-- 以不同影响程度的特定屏障为目标的干预措施，以减少降压 为了改善血压控制而不坚持用药治疗PWH？ Charles Muiruri博士是人口健康科学部(DPHS)的医学讲师 和杜克大学的全球健康研究所。Muiruri博士获得了多样性补充奖，现在 寻求K01奖项，以获得独立资助的健康所需的技能、经验和初步数据 专注于服务的研究计划，专门设计和实施基于证据的 理论上以预防心血管疾病等非艾滋病为基础的干预措施 在威尔斯亲王医院中。 通过该奖项中概述的培训和研究经验，Muiruri博士将利用他的 卫生服务研究中的应用计量经济学和获取患者的混合方法的背景-和 干预措施必须解决的提供者层面的障碍，以减少抗高血压药物的不依从性 (目标1和目标2)针对已实现病毒抑制的威斯康星患者。拟议的工作由一个 实施科学框架，设计和实施以临床为基础的干预措施，以减少 血压控制差的PWH患者的降压药物不依从性(目标3)。职业生涯 发展计划包括实施科学理论培训、特定偏好研究、医学 决策和药物依从性相关科学通过导师、课程和 参加工作小组、专业发展计划和科学会议。 这项研究将为全动力调查员在R01上启动试验奠定基础 实施干预措施。这项工作的洞察力也可能适用于 PWH中的一系列其他非艾滋病情况，如血脂异常。

ABSTRACT Among those with hypertension, persons living with HIV (PWH) have a 50% higher risk of incident myocardial infarction compared to the general population, and they often fail to meet evidence-based treatment goals for hypertension. An important contributing factor for insufficient blood pressure control is nonadherence to antihypertensive medications. Research on medication adherence for PWH has largely focused on antiretroviral therapy adherence with limited focus on adherence to other non-AIDS condition medications. Major determinants of adherence to antihypertensive medications are driven by a confluence of factors that operate at the patient, provider, and healthcare system levels. However, there is a lack of data on how to harness these levels of influence to impact initiation, implementation, and management of adherence to antihypertensive medications for PWH and hypertension. The question, then, is how can we adapt evidence- based interventions to target specific barriers at different levels of influence to reduce antihypertensive medication nonadherence for PWH in order to improve blood pressure control? Dr. Charles Muiruri is a medical instructor in the Department of Population Health Sciences (DPHS) and Global Health Institute at Duke University. Dr. Muiruri received a diversity supplemental award and now seeks a K01 award to gain skills, experience, and preliminary data needed for an independently funded, health services–focused research program that specializes in designing and implementing evidence-based interventions that are grounded in theory to prevent non-AIDS conditions such as cardiovascular disease among PWH. Through the training and research experience outlined in this award, Dr. Muiruri will utilize his background in applied econometrics in health services research and mixed methods to capture patient- and provider-level barriers that an intervention must address to reduce antihypertensive medication nonadherence (Aims 1 and 2) for PWH who have achieved viral suppression. The proposed work is guided by an implementation science framework to design and implement a clinic-based intervention to reduce antihypertensive medication nonadherence for PWH who have poor blood pressure control (Aim 3). The career development plan includes training in implementation science theory, stated-preference research, medical decision making, and medication adherence-related sciences through mentorship, coursework, and participation in working groups, professional development programs, and scientific meetings. This study will lay the groundwork for a fully powered investigator initiated R01 trial on the implementation of the intervention. Insights from this work may also be applicable to medication adherence for a range of other non-AIDS conditions among PWH, such as dyslipidemia.