Leveraging existing HIV differentiated service delivery models to screen and treat hypertension in Ugandan persons living with HIV for dual control

利用现有的艾滋病毒差异化服务提供模式对乌干达艾滋病毒感染者进行高血压筛查和治疗，实现双重控制

• 批准号: 10872353
• 负责人: Martin Muddu
• 金额: $ 10万
• 依托单位: INFECTIOUS DISEASES RES COLLABORATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10872353
• 关键词: Address; Adult; Adverse drug event; Adverse event; Age; Age Distribution; Aging; Angioneurotic Edema; Antihypertensive Agents; Applications Grants; Blood Glucose; Caring; Categories; Chronic; Clinic; Communities; Coughing; Creatinine; Data; Decision Aid; Development; Diabetes Mellitus; Disease; Dose; Edema; Effectiveness; Elderly; Electrolytes; Epidemiology; Event; Fasting; Frequencies; Future; Gender; Goals; Guidelines; HIV; Health Personnel; Hyperglycemia; Hyperlipidemia; Hypertension; Hyponatremia; Incidence; Individual; Inflammation; Kidney Function Tests; Knowledge; Laboratories; Lipids; Measurement; Metabolic syndrome; Methods; Modeling; Monitor; Parents; Participant; Patients; Peripheral; Persons; Pharmaceutical Preparations; Polypharmacy; Potassium; Prospective cohort; Provider; Quasi-experiment; Recommendation; Regimen; Research; Resource-limited setting; Safety; Serum; Service delivery model; Severities; Signs and Symptoms; Sodium; Surveys; Symptoms; Testing; Time; Uganda; Urea; adverse event monitoring; antiretroviral therapy; cohort; cost; experience; health training; hyperkalemia; hypertension treatment; hypertensive; implementation evaluation; implementation science; improved; kidney dysfunction; longitudinal analysis; low income country; multiple chronic conditions; pragmatic implementation; predictive modeling; response; screening; treatment guidelines; trial comparing

Project summary Increased access to antiretroviral therapy has improved survival among persons living with HIV (PLHIV) and increased the proportion of elderly PLHIV (≥50 years) to >20% worldwide. Aging PLHIV experience higher rates of chronic non-communicable diseases (NCDs) including hypertension (HTN), kidney dysfunction, diabetes mellitus, metabolic syndrome and hyperlipidemia due to the ART and HIV-associated chronic inflammation. Concurrent administration of ART and medications for hypertension and other NCDs also raises concerns for medication-related adverse events, including adverse signs and symptoms and laboratory abnormalities. Little is known about the frequency or severity of adverse medication events among aging PLHIV in low-income countries like Uganda. The Uganda national guidelines for HIV management recommend monitoring for hypertension medication adverse events among PLHIV. However, adverse events monitoring is not happening routinely. In our parent K43 project, we are using implementation science methods and a quasi- experimental trial to compare clinic and community-based models for treating aging hypertensive PLHIV, following Uganda national treatment guidelines. To address the epidemiologic and implementation gap on adverse event monitoring, we have developed the current supplement proposal to add several research question to our K43 cohort to characterize the incidence, types, severity and predictors of hypertension medication adverse events among aging PLHIV and inform the development of management approaches. This study will generate pilot data for future research to evaluate the implementation, effectiveness, and costs of an adverse events screening and management strategy and decision aid for providers and patients.

项目摘要 获得抗逆转录病毒治疗的机会增加，改善了艾滋病毒感染者的生存率， 全球老年艾滋病毒感染者（≥50岁）比例增加至>20%。老年人感染艾滋病毒的经验更高 慢性非传染性疾病（NCD）的发病率，包括高血压（HTN）、肾功能障碍、 糖尿病，代谢综合征和高脂血症由于ART和艾滋病毒相关的慢性 炎症抗逆转录病毒疗法与治疗高血压和其他非传染性疾病的药物同时使用， 对药物相关不良事件的担忧，包括不良体征和症状以及实验室检查 异常关于老年人中药物不良事件的频率或严重程度知之甚少 艾滋病毒感染者在低收入国家，如乌干达。乌干达国家艾滋病毒管理指南建议 艾滋病病毒感染者高血压药物不良事件监测。然而，不良事件监测是 而不是例行公事。在我们的母K43项目中，我们使用了实现科学方法和准 实验性试验，以比较临床和社区为基础的模式，用于治疗老年高血压PLHIV， 根据乌干达国家治疗指南。为了解决流行病学和执行方面的差距， 不良事件监测，我们制定了当前的补充建议，以增加几项研究 我们的K43队列的问题，以描述高血压的发病率，类型，严重程度和预测因素 药物不良事件之间的老龄化艾滋病毒感染者，并告知管理方法的发展。这 这项研究将为未来的研究提供试点数据，以评估一项 不良事件筛查和管理策略以及为供应商和患者提供的决策帮助。