Dyadic management of HIV cardiometabolic comorbidities among couples in Malawi

马拉维夫妇艾滋病毒心脏代谢合并症的二元管理

• 批准号: 10265482
• 负责人: Amy Anne Conroy
• 金额: $ 72.83万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-20 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10265482
• 关键词: Adherence; Africa South of the Sahara; African; Area; Attention; Behavior; Belief; Blood Pressure; Cardiometabolic Disease; Caregivers; Caring; Cause of Death; Clinic; Clinical; Communities; Complex; Couples; Data; Diabetes Mellitus; Disease; Disease Management; Eating; Enrollment; Epidemic; Focus Groups; Food; Goals; HIV; Health; Health behavior; Health system; Healthcare Systems; Heart Diseases; Hematological Disease; Home; Hypertension; Individual; Intervention; Interview; Knowledge; Life Style; Literature; Lung diseases; Malawi; Medical; Methods; Modeling; Morbidity - disease rate; Myocardial Infarction; Outcome; Participant; Patients; Pharmaceutical Preparations; Phase; Practice Management; Prevention; Process; Public Health; Reporting; Research; Sampling; Social support; Sodium Chloride; Structure; Sum; Surface; Target Populations; Testing; United States National Institutes of Health; Viral Load result; Water; Witchcraft; antiretroviral therapy; base; cardiometabolism; cardiovascular disorder risk; care providers; clinical practice; commune; comorbidity; contextual factors; coping; design; dietary; disorder control; food insecurity; good diet; health belief; improved; knowledge base; mortality; recruit; response; salt intake; theories; tool

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.

项目摘要/摘要 由于撒哈拉以南非洲的艾滋病毒流行及其有效的抗逆转录病毒疗法，心脏代谢 疾病（CMD）是艾滋病毒患者的下一个主要挑战。例如，在马拉维，大约27％ 患有艾滋病毒的人患有合并性高血压或糖尿病。如果没有使用工具来解决合并症 可用，即在夫妻中的社会支持，我们可能会反向艾滋病毒结果和错过 减少与CMD相关的死亡率和发病率的机会。研究表明，公共 夫妻中的应对对于单个健康状况的二元管理至关重要。然而对 夫妻如何管理多个竞争健康状况，这些状况更加复杂，可以 对健康有协同影响。知识的额外差距仍在非洲背景下。没有研究 已经确定了二元管理中涉及的结构性因素，例如食物或水不安全感，可以 干扰遵守饮食建议或CMD的健康信念，这可能会影响公共应对。 在我们可以干预可以改变的二元过程之前，我们需要获得更深入的文化 - 对健康信念，结构性障碍和公共应对的相互作用的基本了解可能 影响二元管理。我们的目标是生成以经验驱动的概念模型来解释 二元管理并确定干预的机会。我们将使用三相完成此操作 混合方法设计。目标人群将是至少有艾滋病毒伴侣的已婚夫妇， 从马拉维Zomba的HIV诊所招募的CMD（高血压或糖尿病）。我们的具体目的是：（1） 为了开发有关HIV和CMD二元管理的概念模型，从而扩展了知识 基于多种健康状况的二元管理； （2）在纵向中测试概念模型 艾滋病毒和CMD的夫妇样本； （3）根据 发现。对于AIM 1，我们将对25对夫妇进行深入的访谈，以评估对CMD和HIV的信念， 夫妻如何优先级条件并参与公共应对，以及障碍/促进者的二元组 管理。这些数据与理论和文学结合在一起，将导致初步的概念 AIM 2的模型和精制假设。对于AIM 2，我们将注册250对夫妇并测试我们的概念模型 包含有关健康信念，公共应对，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AIM 3，我们将与 关键利益相关者获得干预的潜在组成部分的投入。我们的长期目标是改善 撒哈拉以南非洲的艾滋病毒和CMD合并症的临床实践和疾病管理结果 NIH的高优先区域。概念模型将构成实施和测试的未来研究的基础 一种基于夫妇的新方法，以改善二元管理，有可能告知其他心脏，肺， 艾滋病毒患者中的血液疾病。