Dyadic management of HIV cardiometabolic comorbidities among couples in Malawi

项目总结/摘要 随着艾滋病毒流行在撒哈拉以南非洲的成熟，有效的抗逆转录病毒治疗，心脏代谢 疾病（CMD）是艾滋病毒感染者面临的下一个主要挑战。例如，在马拉维， 的艾滋病毒感染者同时患有高血压或糖尿病。如果未使用工具解决合并症 如果我们提供社会支持，即夫妇之间的社会支持，我们可能会逆转在艾滋病毒成果方面取得的进展， 降低CMD相关死亡率和发病率的机会。研究表明， 夫妻间的应对对于单一健康状况的双重管理至关重要。但很少有人知道 夫妻如何管理多种相互竞争的健康状况，这些状况要复杂得多， 对健康产生协同效应。非洲在知识方面还存在其他差距。没有研究 已经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， 干扰对饮食建议的遵守，或对CMD的健康信念，这可能会影响社区应对。 在我们能够干预易于改变的二元过程之前，我们需要获得更深层次的文化- 对健康信念、结构性障碍和社区应对之间相互作用的基础理解， 影响二元管理。我们的目标是生成一个由计算机驱动的概念模型， 双元管理，并确定干预的机会。我们将使用三相 混合方法设计目标人群将是至少有一名伴侣感染艾滋病毒的已婚夫妇， CMD（高血压或糖尿病）从马拉维Zomba的艾滋病毒诊所招募。我们的具体目标是：（1） 开发一个关于艾滋病毒和CMD的二元管理的概念模型，从而扩展知识， 基于多种健康状况的二元管理;（2）纵向测试概念模型 艾滋病毒感染者和CMD夫妇的样本;（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， 夫妇如何优先考虑条件和参与社区应对，以及二元关系的障碍/促进因素 管理这些数据，结合理论和文献，将产生一个初步的概念 目标2的模型和完善的假设。对于目标2，我们将招募250对夫妇并测试我们的概念模型 包含健康信念、社区应对、二元管理行为、疾病 控制结果和心血管疾病风险。就目标3而言，我们会与 关键利益攸关方就干预措施的潜在组成部分征求意见。我们的长期目标是改善 撒哈拉以南非洲艾滋病毒和CMD合并症的临床实践和疾病管理结果-a 国家卫生研究院的高优先领域。该概念模型将构成未来研究的基础，以实现和测试 一种新的夫妇为基础的方法，以改善二元管理的潜力，通知其他心脏，肺， 和血液疾病的风险。

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.