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

摘要 在高血压患者中，艾滋病毒感染者（PWH）发生心肌梗死的风险高出50%。 与一般人群相比，他们经常无法达到基于证据的治疗目标， 高血压血压控制不充分的一个重要因素是不遵守 抗高血压药物PWH的药物依从性研究主要集中在 抗逆转录病毒治疗依从性，对其他非艾滋病药物治疗依从性的关注有限。 抗高血压药物依从性的主要决定因素是由多种因素共同驱动的， 在患者、提供者和医疗保健系统层面运作。然而，缺乏数据说明如何 利用这些层次的影响力，影响遵守的启动、实施和管理， PWH和高血压的降压药物。所以，问题是，我们如何调整证据- 针对不同影响水平的特定障碍进行干预，以减少抗高血压药物 为了改善血压控制，PWH的药物不依从性？ Charles Muiruri博士是人口健康科学系的医学讲师 和杜克大学全球健康研究所。Muiruri博士获得了多样性补充奖，现在 寻求K 01奖，以获得独立资助的健康所需的技能，经验和初步数据， 一个以服务为中心的研究计划，专门设计和实施基于证据的 以预防心血管疾病等非艾滋病疾病为理论基础的干预措施 在PWH。 通过该奖项中概述的培训和研究经验，Muiruri博士将利用他的 背景应用计量经济学在卫生服务研究和混合方法，以捕捉病人-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不依从性 (Aims 1和2）的PWH谁已经达到病毒抑制。拟议工作的指导方针是 实施科学框架，以设计和实施基于临床的干预措施， 血压控制不佳的PWH患者的抗高血压药物不依从性（目的3）。职业 发展计划包括实施科学理论，国家偏好研究，医疗 决策，和药物依从性相关的科学，通过指导，课程， 参加工作组、专业发展计划和科学会议。 这项研究将为研究者启动的R 01试验奠定基础。 实施干预。这项工作的见解也可能适用于药物依从性， 在威尔斯亲王医院中，有一系列其他非爱滋病的情况，例如血脂异常。

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.