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.

项目概要 抗逆转录病毒治疗的普及提高了艾滋病毒感染者 (PLHIV) 的生存率 全球老年艾滋病毒感染者（≥50 岁）的比例增加至 20% 以上。 慢性非传染性疾病（NCD）的发病率，包括高血压（HTN）、肾功能不全、 ART 和 HIV 相关慢性病引起的糖尿病、代谢综合征和高脂血症 同时使用抗逆转录病毒疗法和治疗高血压和其他非传染性疾病的药物也会增加炎症。 对药物相关不良事件的担忧，包括不良体征和症状以及实验室检查 对于老年人中不良药物事件的频率或严重程度知之甚少。 乌干达等低收入国家的艾滋病毒感染者 乌干达国家艾滋病毒管理指南建议。 艾滋病毒感染者药物不良事件的高血压监测 然而，不良事件监测是。 在我们的父 K43 项目中，我们正在使用实施科学方法和准- 比较临床和社区模型治疗老年高血压 PLHIV 的实验性试验， 遵循乌干达国家治疗指南，以解决流行病学和实施方面的差距。 不良事件监测，我们制定了当前的补充提案以添加多项研究 向我们的 K43 队列提出问题，以描述高血压的发病率、类型、严重程度和预测因素 老年艾滋病感染者的药物不良事件并为管理方法的制定提供信息。 研究将为未来的研究生成试点数据，以评估一项研究的实施、有效性和成本 不良事件筛查和管理策略以及为提供者和患者提供决策帮助。