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

为感染艾滋病毒和高血压的老年人提供基于社区的药物依从性支持（CBA 干预）

• 批准号: 10752723
• 负责人: Jepchirchir Kiplagat
• 金额: $ 11.34万
• 依托单位: MOI UNIVERSITY COLLEGE OF HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-15 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10752723
• 关键词: Achievement; Acute myocardial infarction; Address; Adherence; Adverse effects; Africa South of the Sahara; Age; Aging; Agreement; Antihypertensive Agents; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Caring; Chronic; Chronic Disease; Clinical Trials; Communities; Community Health; Complex; Consolidated Framework for Implementation Research; Coupled; Data; Disease; Doctor of Philosophy; Elderly; Evaluation; Event; Fellowship; Focus Groups; Funding; General Population; Goals; HIV; HIV Infections; Health; Health behavior; Home visitation; Hypertension; Individual; International; Intervention; Kenya; Knowledge; Life Expectancy; Mentors; Metabolic Diseases; Modeling; Morbidity - disease rate; Myocardial Infarction; Neurocognitive Deficit; Outcome; Outcomes Research; Persons; Pharmaceutical Economics; Pharmaceutical Preparations; Pharmacists; Phase; Polypharmacy; Population; Process; Public Health; Qualifying; Research; Research Infrastructure; Research Personnel; Risk; Risk Reduction; Social support; Societies; Time; Training; Transportation; Universities; aged; antiretroviral therapy; blood pressure control; budget impact; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular risk factor; career development; cognitive function; comorbidity; cost; cost effective; design; differences in access; economic evaluation; evidence base; experience; health care availability; human centered design; hybrid type 2 trial; hypertension control; implementation outcomes; implementation research; implementation science; improved; iterative design; low and middle-income countries; medication compliance; mortality; novel; patient oriented; pill; post intervention; primary outcome; skills; theories; therapy design; therapy development; volunteer

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.

项目摘要 由于艺术的可用性越来越大，艾滋病毒（PLWH）的人生存更长并实现生命 期望与普通人群类似。虽然这是一个伟大的成就，但不可传播的疾病 例如心血管疾病（CVD）现在占发病率和死亡率的很大比例 plwh。 HTN药物依从性差与不受控制的血压（BP）有关 CVD事件（例如心肌梗塞）的风险。尽管有这种风险，但PLWH的药物依从性研究是 主要专注于艺术，而对其他慢性合并症的遵守有限。 药物依从性是一种复杂的健康行为，是由运作的因素汇合而驱动的 微观和宏观水平。随着艾滋病毒的年龄，他们的需求不仅会增加艾滋病毒 药物依从性，包括对其他疾病及其药物的管理。增加药丸负担 面对HIV（OALWH）HTN的老年人面对，再加上认知功能的下降，成本 运输到设施以获得药物补充和缺乏社会支持的依从性。差异 特别是在LMIC中访问，而在LMIC中，ART是免费的，HTN药物没有，更广泛的不良效应概况 HTN药物以及HTN护理中缺乏质质的药物也可能导致不遵守。依从性支持 OALWH具有针对这些因素的HTN可能有助于改善药物依从性并减少CVD事件。 在此K43申请中，申请人提出了一项培训计划，该计划将使她的获得技能和专业知识 以人为本的设计方法，实施科学理论，模型和框架以及经济 评估健康干预措施。她的研究将解决以下特定目标：共同设计小说 CHV领导的药物依从性支持模型（CBA干预）使用以人为中心 设计方法（AIM 1）；进行CBA干预的试点并评估其可行性（AIM2）；和行为 CBA干预的成本和预算影响分析（AIM 3）。拟议的K43职业发展 包括拟议研究结果在内的活动将在我向独立的过渡中达到顶峰 研究人员（R01资助），在艾滋病毒和衰老领域做出了贡献。