Community-based Medication Adherence Support for Older Adults Living with HIV and Hypertension (CBA Intervention)

项目摘要 由于抗逆转录病毒疗法的日益普及，艾滋病毒感染者（PLWH）的生存时间更长， 与一般人群相似的期望。虽然这是一项伟大的成就，但非传染性疾病 如心血管疾病（CVD）现在占发病率和死亡率的很大比例， PLWH。HTN药物依从性差与血压（BP）不受控制相关， 心血管事件的风险，如心肌梗死。尽管存在这种风险，但PLWH的药物依从性研究仍然是 主要关注ART，对其他慢性合并症的依从性关注有限。 药物依从性是一种复杂的健康行为，由多种因素共同驱动， 微观和宏观层面。随着艾滋病毒感染者的年龄增长，他们的需求增加，不仅仅是管理艾滋病毒 药物依从性，包括其他条件及其药物的管理。药丸负担增加 老年艾滋病毒感染者（OALWH）面临的HTN，加上认知功能下降， 到医院补充药物的交通和缺乏社会支持使依从性恶化。差异 特别是在抗逆转录病毒治疗免费而高血压药物不免费的中低收入国家， HTN药物和HTN护理中缺乏多药治疗也可能导致不依从性。支持遵守 OALWH与HTN针对这些因素可能有助于提高药物依从性和减少CVD事件。 在此K43申请中，申请人提出了一个培训计划，使她能够获得以下技能和专业知识： 以人为本的设计方法，实现科学理论，模型和框架，以及经济 评估卫生干预措施。她的研究将解决以下具体目标：共同设计一部小说 CHV主导的OALWH药物依从性支持（CBA干预）模型，使用以人为中心的 设计方法（目标1）;进行社区效益分析干预试点并评估其可行性（目标2）;以及 成本效益分析和预算影响分析（目标3）。K43职业发展 活动，包括拟议的研究成果将最终在我过渡到一个独立的 研究人员（R 01资助），在艾滋病毒和老龄化领域做出贡献。

PROJECT SUMMARY Due to the increasing availability of ART, people living with HIV (PLWH) are surviving longer and achieving life expectancies similar to the general population. While this is a great achievement, noncommunicable diseases such as cardiovascular disease (CVD) now account for a significant proportion of the morbidity and mortality in PLWH. Poor HTN medication adherence is associated with uncontrolled blood pressure (BP) and increased risk of CVD events such as myocardial infarction. Despite this risk, medication adherence research in PLWH is primarily focused on ART with limited focus on adherence to other chronic comorbidities. Medication adherence is a complex health behaviour that is driven by confluence of factors that operate at micro- and macro-levels. As people age with HIV, their needs increase beyond solely managing HIV medication adherence, to include management of other conditions and their medications. Increased pill burden faced by older adults living with HIV (OALWH) with HTN, coupled with decline in cognitive function, cost of transportation to the facility to get medication refill and lack of social support worsen adherence. Differences in access particularly in LMICs, where ART is free and HTN medication are not, wider adverse effect profiles of HTN drugs, and lack of polypills in HTN care could also contribute to non-adherence. Adherence support for OALWH with HTN targeted at these factors may help improve medication adherence and reduce CVD events. In this K43 application, the applicant proposes a training plan that will enable her gain skills and expertise in human-centered design approach, implementation science theories, models and frameworks, and economic evaluation of health interventions. Her research will addressing the following specific aims: Co-design a novel CHV-led model for medication adherence support (CBA intervention) for OALWH using a human-centered design approach (Aim 1); Conduct a pilot of CBA intervention and evaluate its feasibility (Aim2); and Conduct costing and budget impact analysis of CBA intervention (Aim 3). The proposed K43 career development activities including the outcome of the proposed research will culminate in my transition to an independent researcher (R01-funded), contributing in the field of HIV and aging.