Determinants of Medication Adherence in HIV-Infected Adults with Hypertension

HIV 感染成人高血压患者药物依从性的决定因素

• 批准号: 8070092
• 负责人: JEFFREY J WEISS
• 金额: $ 25.43万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-24 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8070092
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Adverse effects; Affect; Age; Anti-Retroviral Agents; Antihypertensive Agents; Attention; Belief; Cardiovascular Diseases; Caring; Cause of Death; Chronic; Chronic Disease; Comorbidity; Complication; Development; Disease; Electronics; Ethnic Origin; Future; Goals; Grant; HIV; HIV Infections; HIV Seropositivity; High Prevalence; Hispanics; Hypertension; Individual; Informal Social Control; Intervention; Kidney Failure; Knowledge; Life; Medical; Minority Groups; Modeling; Monitor; Morbidity - disease rate; Not Hispanic or Latino; Nurses; Outcome; Patients; Pattern; Perception; Persons; Pharmaceutical Preparations; Play; Population; Public Health; Race; Regimen; Research; Risk Factors; Role; Sampling; Self Management; Staging; Stroke; Translating; antiretroviral therapy; base; cardiovascular disorder risk; cost; disorder control; disorder risk; effective intervention; efficacy testing; ethnic minority population; health belief; health disparity; hypertension treatment; illness perceptions; improved; inner city; medication compliance; member; mortality; racial and ethnic; research and development; systolic hypertension; theories

DESCRIPTION (provided by applicant): There is an urgent need for research on medication adherence in HIV-infected individuals that goes beyond ARV therapy and investigates determinants of adherence to medications for medical comorbidities. Due to the development of highly-effective antiretroviral (ARV) therapy, AIDS has been transformed from a fatal illness to a chronic one and mortality due to comorbid conditions has increased considerably among HIV-infected persons. As HIV-infected adults live longer lives, they are increasingly at risk for diseases of aging, including cardiovascular disease (CVD). HIV infection and ARV therapy have been associated with increased risks of CVD, and CVD now ranks as a major cause of death in this population. A major risk factor for CVD is hypertension (HTN), as well as stroke and renal failure (a common complication of HIV infection). Many patients do no achieve adequate disease control, despite the availability of effective medications for HIV and HTN. While medication adherence is a key aspect of chronic disease self-management, it has been well documented that approximately 50% of patients with chronic diseases do not adhere to their medication regimens, a pattern that translates into poor outcomes and increased medical costs. This study proposes to investigate adherence to antihypertensive medication in HIV-infected adults on ARVs with comorbid HTN, one of the most prevalent comorbid conditions in HIV-infected persons. Using Self- Regulation Theory as a framework, the focus will be on identifying potentially modifiable factors that could be the target of future nurse-led interventions to improve adherence, with specific attention for the role of race and ethnicity. The Specific Aims of this study are to: (1) Determine the relationship between disease-specific adherence factors (illness representation and beliefs about the necessity of medication and concerns about potential adverse effects) and adherence to antihypertensive and ARV medication in HIV-positive subjects with comorbid HTN; (2) Explore differences in HIV and HTN illness representation and medication beliefs among the three most prevalent racial/ethnic patient groups (blacks, Hispanics, non-Hispanic whites), controlling for stage of disease. The study will use electronic monitoring to prospectively assess adherence to one antihypertensive and one ARV medication over a 10-week period in an ethnically diverse sample of 200 inner- city HIV-positive subjects. This study will provide a model for integrating adherence to medications for comorbid medical conditions into nurse-led adherence interventions for HIV-infected persons. Study findings will serve as the basis for the development of research which will test the efficacy of a nurse-led adherence intervention targeting both adherence to ARVs and antihypertensives in HIV-infected persons with comorbid HTN. It will produce knowledge which can be used to effectively intervene to decrease the risk for cardiovascular disease among HIV-positive adults on highly-effective ARV therapy. PUBLIC HEALTH RELEVANCE: Hypertension is one of the most prevalent comorbid conditions in persons with HIV-infection and cardiovascular disease now ranks as a major cause of death in this population. This study will investigate determinants of adherence to the treatment of hypertension in HIV-infected persons with the goal of leading to interventions to decrease the risk for cardiovascular disease among HIV- positive adults on highly-effective ARV therapy.

描述（由申请人提供）：迫切需要对HIV感染者的药物依从性进行研究，超越ARV治疗，并调查医疗合并症药物依从性的决定因素。由于高效抗逆转录病毒疗法的发展，艾滋病已从一种致命疾病转变为一种慢性疾病，艾滋病毒感染者因合并症而死亡的人数大幅增加。随着艾滋病毒感染的成年人寿命延长，他们患老年疾病的风险越来越大，包括心血管疾病。HIV感染和抗逆转录病毒治疗与心血管疾病风险增加有关，心血管疾病现在已成为这一人群的主要死因。心血管疾病的一个主要危险因素是高血压（HTN），以及中风和肾衰竭（艾滋病毒感染的常见并发症）。尽管有有效的HIV和HTN药物，但许多患者没有得到充分的疾病控制。虽然药物依从性是慢性病自我管理的一个关键方面，但有充分的证据表明，大约50%的慢性病患者不遵守他们的药物治疗方案，这种模式转化为不良结果和增加的医疗成本。 本研究旨在调查接受抗逆转录病毒药物治疗的HIV感染成人中合并HTN（HIV感染者中最常见的合并症之一）的抗高血压药物依从性。使用自我调节理论作为框架，重点将是确定潜在的可修改的因素，这些因素可能是未来护士主导的干预措施的目标，以提高依从性，特别注意种族和民族的作用。本研究的具体目的是：（1）确定疾病特异性粘附因子之间的关系（疾病陈述和对药物治疗必要性的信念以及对潜在不良反应的担忧）以及对合并HTN的HIV阳性受试者的抗高血压和ARV药物治疗的依从性;（2）探索三个最流行的种族/民族患者群体在艾滋病毒和HTN疾病表现和药物信仰方面的差异（黑人，西班牙裔，非西班牙裔白人），控制疾病的阶段。该研究将使用电子监测，前瞻性评估200名内城HIV阳性受试者的种族多样性样本在10周内对一种抗高血压药物和一种ARV药物的依从性。这项研究将提供一个模型，将合并症的药物治疗依从性纳入护士主导的艾滋病毒感染者依从性干预措施。研究结果将作为基础的发展研究，这将测试的效果，护士主导的坚持干预，针对艾滋病毒感染者与共病HTN坚持抗逆转录病毒药物和抗高血压药物。它将产生可用于有效干预的知识，以降低接受高效抗逆转录病毒治疗的艾滋病毒阳性成年人患心血管疾病的风险。 公共卫生相关性：高血压是艾滋病毒感染者中最常见的共病之一，心血管疾病现已成为这一人群的主要死亡原因。本研究将调查HIV感染者坚持高血压治疗的决定因素，目的是采取干预措施，降低接受高效抗逆转录病毒治疗的HIV阳性成年人患心血管疾病的风险。