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

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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.