Addressing barriers to anti-hypertensive medication adherence among persons living who have achieved viral suppression

解决已实现病毒抑制的活着的人坚持抗高血压药物治疗的障碍

• 批准号: 10281788
• 负责人: Charles Muiruri
• 金额: $ 15.34万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-31 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10281788
• 关键词: AIDS/HIV problem; Achievement; Acute myocardial infarction; Address; Adherence; Antihypertensive Agents; Award; Behavioral; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Caring; Clinic; Data; Decision Making; Development Plans; Dyslipidemias; Enrollment; Evidence based intervention; Evidence based treatment; Frequencies; Funding; General Population; Goals; HIV; Health Sciences; Health Services; Health Services Research; Health system; Healthcare Systems; Home Blood Pressure Monitoring; Human; Hypertension; Institutes; Intervention; Interview; Medical; Mentored Research Scientist Development Award; Mentorship; Methods; Monitor; Morbidity - disease rate; Myocardial Infarction; Nurses; Outcome; Patients; Perception; Persons; Pharmaceutical Preparations; Physicians; Program Development; Provider; Qualitative Methods; Research; Research Personnel; Risk; Science; Structure; Surveys; Time; Training; United States; Universities; Viral; Work; antiretroviral therapy; base; behavior change wheel; blood pressure regulation; cardiovascular disorder prevention; cardiovascular disorder risk; care providers; career development; comorbidity; cost; design; dosage; econometrics; evidence base; experience; global health; high risk; hypertension treatment; implementation framework; implementation intervention; implementation science; improved; insight; instructor; medication compliance; medication nonadherence; meetings; mortality; multi-component intervention; patient-level barriers; population health; preference; prevent; programs; provider-level barriers; side effect; skills; theories; therapy adherence; therapy design; working group

ABSTRACT Among those with hypertension, persons living with HIV (PWH) have a 50% higher risk of incident myocardial infarction compared to the general population, and they often fail to meet evidence-based treatment goals for hypertension. An important contributing factor for insufficient blood pressure control is nonadherence to antihypertensive medications. Research on medication adherence for PWH has largely focused on antiretroviral therapy adherence with limited focus on adherence to other non-AIDS condition medications. Major determinants of adherence to antihypertensive medications are driven by a confluence of factors that operate at the patient, provider, and healthcare system levels. However, there is a lack of data on how to harness these levels of influence to impact initiation, implementation, and management of adherence to antihypertensive medications for PWH and hypertension. The question, then, is how can we adapt evidence- based interventions to target specific barriers at different levels of influence to reduce antihypertensive medication nonadherence for PWH in order to improve blood pressure control? Dr. Charles Muiruri is a medical instructor in the Department of Population Health Sciences (DPHS) and Global Health Institute at Duke University. Dr. Muiruri received a diversity supplemental award and now seeks a K01 award to gain skills, experience, and preliminary data needed for an independently funded, health services–focused research program that specializes in designing and implementing evidence-based interventions that are grounded in theory to prevent non-AIDS conditions such as cardiovascular disease among PWH. Through the training and research experience outlined in this award, Dr. Muiruri will utilize his background in applied econometrics in health services research and mixed methods to capture patient- and provider-level barriers that an intervention must address to reduce antihypertensive medication nonadherence (Aims 1 and 2) for PWH who have achieved viral suppression. The proposed work is guided by an implementation science framework to design and implement a clinic-based intervention to reduce antihypertensive medication nonadherence for PWH who have poor blood pressure control (Aim 3). The career development plan includes training in implementation science theory, stated-preference research, medical decision making, and medication adherence-related sciences through mentorship, coursework, and participation in working groups, professional development programs, and scientific meetings. This study will lay the groundwork for a fully powered investigator initiated R01 trial on the implementation of the intervention. Insights from this work may also be applicable to medication adherence for a range of other non-AIDS conditions among PWH, such as dyslipidemia.

抽象的 在患有高血压的患者中，患有艾滋病毒（PWH）的人患有心肌风险高50％ 与一般人群相比，梗塞梗塞，他们通常无法实现基于证据的治疗目标 高血压。血压控制不足的重要因素是不遵守 降压药。 PWH的药物依从性研究主要集中在 抗逆转录病毒疗法的依从性有限，重点是遵守其他非AID疾病药物。 主要确定遵守降压药的是由多种因素驱动的 在患者，提供者和医疗保健系统水平上运作。但是，缺乏有关如何的数据 利用这些影响力来影响倡议，实施和管理遵守 PWH和高血压的降压药。因此，问题是我们如何适应证据 - 基于不同影响力的特定障碍的基于干预措施，以减少降压 PWH的药物不遵守是为了改善血压控制吗？ Charles Muiruri博士是人口健康科学系（DPHS）的医学讲师 和杜克大学的全球健康研究所。 Muiruri博士获得了多样性补充奖项，现在 寻求K01奖，以获得独立资助的健康所需的技能，经验和初步数据 服务与专注于设计和实施基于证据的研究计划 理论上基于预防非辅助疾病（例如心血管疾病）的干预措施 在PWH中。 通过该奖项中概述的培训和研究经验，Muiruri博士将利用他的 卫生服务研究中应用经济学的背景以及捕获患者和患者的混合方法 提供者级别的障碍必须解决，以减少降压药不遵守 （目标1和2）对于已经实现了病毒抑制的PWH。拟议的工作由 实施科学框架以设计和实施基于诊所的干预措施以减少 对血压控制不良的PWH的降压药不遵守（AIM 3）。职业 开发计划包括实施科学理论的培训，陈述的优先研究，医学 决策和药物依从性相关的科学通过指导，课程和 参加工作组，专业发展计划和科学会议。 这项研究将为一名功能齐全的调查员奠定基础，启动了R01试验 干预的实施。这项工作的见解也可能适用于药物依从性 PWH中的其他一系列非AID条件，例如血脂异常。