Dyadic management of HIV cardiometabolic comorbidities among couples in Malawi

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Project Summary/Abstract As the HIV epidemic matures in sub-Saharan Africa with effective antiretroviral therapy, cardiometabolic disorders (CMD) are the next major challenge for people living with HIV. In Malawi, for example, around 27% of people living with HIV have comorbid hypertension or diabetes. If comorbidities are not addressed with tools available, namely social support in couples, we may reverse progress made towards HIV outcomes and miss opportunities to reduce mortality and morbidity associated with CMD. Research has shown that communal coping in couples is essential for the dyadic management of single health conditions. Yet little is known about how couples manage multiple competing health conditions, which are significantly more complex and could have synergistic impacts on health. Additional gaps in knowledge remain in the African context. No research has identified the structural factors involved in dyadic management such as food or water insecurity, which can interfere with adherence to dietary advice, or health beliefs around CMD, which may impact communal coping. Before we can intervene on dyadic processes amenable to change, we need to gain a deeper and culturally- grounded understanding of the interplay of health beliefs, structural barriers, and communal coping that may impact dyadic management. Our objective is to generate an empirically-driven conceptual model explaining dyadic management and to identify opportunities for intervention. We will accomplish this using a three-phase mixed-methods design. The target population will be married couples with at least one partner with HIV and CMD (either hypertension or diabetes) recruited from HIV clinics in Zomba, Malawi. Our specific aims are: (1) to develop a conceptual model on the dyadic management of HIV and CMD, thereby extending the knowledge base on dyadic management of multiple health conditions; (2) to test the conceptual model in a longitudinal sample of couples living with HIV and CMD; and (3) to identify opportunities for an intervention based on the findings. For Aim 1, we will conduct in-depth interviews with 25 couples to assess beliefs about CMD and HIV, how couples prioritize conditions and engage in communal coping, and barriers/facilitators to dyadic management. These data, in conjunction with the theory and literature, will result in a preliminary conceptual model and refined hypotheses for Aim 2. For Aim 2, we will enroll 250 couples and test our conceptual model containing explanatory variables on health beliefs, communal coping, dyadic management behaviors, disease control outcomes, and cardiovascular disease risk. For Aim 3, we will conduct focus group discussions with key stakeholders to gain input on potential components for an intervention. Our long-term goal is to improve clinical practice and disease management outcomes for HIV and CMD comorbidities in sub-Saharan Africa—a high-priority area of the NIH. The conceptual model will form the basis of future research to implement and test a new couple-based approach to improve dyadic management with the potential to inform other heart, lung, and blood disorders among people with HIV.