Determinants of Medication Adherence in HIV-Infected Adults with Hypertension

描述（由申请人提供）：迫切需要对艾滋病毒感染者的药物依从性进行研究，该研究超出了抗逆转录病毒药物治疗的范围，并调查了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（ARV）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造成的死亡率大幅增加。随着感染艾滋病毒的成年人寿命延长，他们患老年疾病的风险越来越大，包括心血管疾病（CVD）。艾滋病毒感染和抗逆转录病毒治疗与心血管疾病的风险增加有关，心血管疾病现在是这一人群死亡的主要原因。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（HIV感染的常见并发症）。尽管有针对艾滋病毒和HTN的有效药物，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疾病自我管理的一个关键方面，但有充分的证据表明，大约50%的慢性疾病患者不坚持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费用。本研究旨在调查艾滋病毒感染者中最常见的合并症之一HTN，即接受arv治疗并伴有HTN的成人抗高血压药物的依从性。使用自我调节理论作为框架，重点将放在识别潜在的可改变的因素，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，特别关注种族和民族的作用。本研究的具体目的是：(1)确定合并HTN的hiv阳性受试者的疾病特异性依从性因素（疾病表征和对药物必要性的信念以及对潜在不良反应的担忧）与降压和抗逆转录病毒药物依从性之间的关系；(2)在控制疾病分期的情况下，探讨三个最流行的种族/民族患者群体（黑人、西班牙裔、非西班牙裔白人）在HIV和HTN疾病表征和用药信念方面的差异。这项研究将使用电子监测来前瞻性地评估在10周内200名不同种族的城市hiv阳性受试者对一种抗高血压药物和一种抗逆转录病毒药物的依从性。本研究将提供一个模型，将依从性药物治疗合并症纳入护士主导的艾滋病毒感染者依从性干预措施。研究结果将作为开展研究的基础，这些研究将测试护士主导的针对艾滋病毒感染合并HTN患者坚持使用抗逆转录病毒药物和抗高血压药物的依从性干预措施的有效性。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药物治疗的艾滋病毒阳性成人患心血管疾病的风险。

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.