Dyadic management of HIV cardiometabolic comorbidities among couples in Malawi

项目摘要/摘要 随着艾滋病毒在撒哈拉以南非洲地区的流行成熟，采用有效的抗逆转录病毒治疗，心脏代谢 疾病(CMD)是艾滋病毒携带者面临的下一个主要挑战。例如，在马拉维，大约27%的人 的艾滋病毒携带者患有高血压或糖尿病。如果不使用工具解决并存问题 如果我们能够获得，即夫妻间的社会支持，我们可能会逆转在艾滋病毒结果方面取得的进展，并错失 减少与CMD相关的死亡率和发病率的机会。研究表明，社区 夫妻之间的应对对于单身健康状况的二元管理是必不可少的。然而，人们对此知之甚少。 夫妇如何管理多种相互竞争的健康状况，这些状况要复杂得多，而且可能 对健康产生协同影响。在非洲的背景下，知识方面的更多差距依然存在。没有研究 确定了二元管理中涉及的结构性因素，如粮食或水的不安全，这可能 干扰对饮食建议的坚持，或对CMD的健康信念的坚持，这可能会影响社区应对。 在我们能够干预服从变化的二元进程之前，我们需要获得更深层次的和文化上的-- 对健康信念、结构性障碍和社区应对之间的相互作用的扎实理解可能 冲击二元管理。我们的目标是生成一个经验驱动的概念模型来解释 二元管理和确定干预的机会。我们将通过三个阶段来实现这一点 混合方法设计。目标人群将是已婚夫妇，至少有一人感染艾滋病毒和 从马拉维Zomba的艾滋病毒诊所招募的CMD(高血压或糖尿病)。我们的具体目标是：(一) 开发HIV和CMD二元管理的概念模型，从而扩展知识 基于多健康条件的二元管理；(2)对概念模型进行纵向检验 HIV和CMD携带者夫妇样本；以及(3)根据 调查结果。对于目标1，我们将对25对夫妇进行深入访谈，以评估他们对CMD和HIV的看法， 夫妻如何确定条件的轻重缓急，如何参与社区应对，以及障碍/促进者对二人的影响 管理层。这些数据，结合理论和文献，将导致一个初步的概念 对于目标2，我们将招募250对夫妇并测试我们的概念模型 包含关于健康信念、社区应对、二元管理行为、疾病的解释变量 控制结果和心血管疾病风险。对于目标3，我们将与以下人员进行焦点小组讨论 关键利益攸关方就干预的潜在组成部分获得意见。我们的长期目标是改进 撒哈拉以南非洲地区HIV和CMD共病的临床实践和疾病管理结果-a 美国国立卫生研究院的高度优先领域。该概念模型将成为未来研究实现和测试的基础 一种新的基于夫妇的方法来改进二元组管理，潜在地通知其他心脏，肺， 以及艾滋病毒携带者的血液疾病。

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.