Leveraging existing HIV differentiated service delivery models to screen and treat hypertension in Ugandan persons living with HIV for dual control

利用现有的艾滋病毒差异化服务提供模式对乌干达艾滋病毒感染者进行高血压筛查和治疗，实现双重控制

• 批准号: 10872353
• 负责人: Martin Muddu
• 金额: $ 10万
• 依托单位: INFECTIOUS DISEASES RES COLLABORATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10872353
• 关键词: Address; Adult; Adverse drug event; Adverse event; Age; Age Distribution; Aging; Angioneurotic Edema; Antihypertensive Agents; Applications Grants; Blood Glucose; Caring; Categories; Chronic; Clinic; Communities; Coughing; Creatinine; Data; Decision Aid; Development; Diabetes Mellitus; Disease; Dose; Edema; Effectiveness; Elderly; Electrolytes; Epidemiology; Event; Fasting; Frequencies; Future; Gender; Goals; Guidelines; HIV; Health Personnel; Hyperglycemia; Hyperlipidemia; Hypertension; Hyponatremia; Incidence; Individual; Inflammation; Kidney Function Tests; Knowledge; Laboratories; Lipids; Measurement; Metabolic syndrome; Methods; Modeling; Monitor; Parents; Participant; Patients; Peripheral; Persons; Pharmaceutical Preparations; Polypharmacy; Potassium; Prospective cohort; Provider; Quasi-experiment; Recommendation; Regimen; Research; Resource-limited setting; Safety; Serum; Service delivery model; Severities; Signs and Symptoms; Sodium; Surveys; Symptoms; Testing; Time; Uganda; Urea; adverse event monitoring; antiretroviral therapy; cohort; cost; experience; health training; hyperkalemia; hypertension treatment; hypertensive; implementation evaluation; implementation science; improved; kidney dysfunction; longitudinal analysis; low income country; multiple chronic conditions; pragmatic implementation; predictive modeling; response; screening; treatment guidelines; trial comparing

Project summary Increased access to antiretroviral therapy has improved survival among persons living with HIV (PLHIV) and increased the proportion of elderly PLHIV (≥50 years) to >20% worldwide. Aging PLHIV experience higher rates of chronic non-communicable diseases (NCDs) including hypertension (HTN), kidney dysfunction, diabetes mellitus, metabolic syndrome and hyperlipidemia due to the ART and HIV-associated chronic inflammation. Concurrent administration of ART and medications for hypertension and other NCDs also raises concerns for medication-related adverse events, including adverse signs and symptoms and laboratory abnormalities. Little is known about the frequency or severity of adverse medication events among aging PLHIV in low-income countries like Uganda. The Uganda national guidelines for HIV management recommend monitoring for hypertension medication adverse events among PLHIV. However, adverse events monitoring is not happening routinely. In our parent K43 project, we are using implementation science methods and a quasi- experimental trial to compare clinic and community-based models for treating aging hypertensive PLHIV, following Uganda national treatment guidelines. To address the epidemiologic and implementation gap on adverse event monitoring, we have developed the current supplement proposal to add several research question to our K43 cohort to characterize the incidence, types, severity and predictors of hypertension medication adverse events among aging PLHIV and inform the development of management approaches. This study will generate pilot data for future research to evaluate the implementation, effectiveness, and costs of an adverse events screening and management strategy and decision aid for providers and patients.

项目摘要 增加抗逆转录病毒疗法的机会提高了艾滋病毒（PLHIV）和 在全球范围内将较早的PLHIV（≥50岁）的比例提高到> 20％。老化的PLHIV经验更高 慢性非通信疾病（NCD）的发生率，包括高血压（HTN），肾功能障碍， 由于ART和HIV相关的慢性，糖尿病，代谢综合征和高脂血症 炎。同时管理高血压和其他NCD的艺术和药物也会提高 担心与药物有关的不良事件，包括广告标志和症状以及实验室 异常。关于衰老中广告药物事件的频率或严重性知之甚少 乌干达等低收入国家的PLHIV。乌干达国家艾滋病毒管理指南建议 监测PLHIV之间的高血压药物不良事件。但是，不良事件监视是 不常规发生。在我们的家长K43项目中，我们正在使用实施科学方法和准 实验试验比较用于治疗衰老高血压PLHIV的诊所和社区模型， 遵循乌干达国家治疗指南。解决流行病学和实施差距 不良事件监控，我们已经开发了当前的补充建议来添加一些研究 向我们的K43队列提出问题，以表征高血压的事件，类型，严重性和预测指标 衰老的PLHIV中的药物不良事件并告知管理方法的发展。这 研究将生成未来研究的试点数据，以评估 不良事件筛查和管理策略以及针对提供者和患者的决策援助。