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.

项目概要 由于抗逆转录病毒治疗的日益普及，艾滋病毒感染者 (PLWH) 的生存时间更长，并实现了生命的目标 与一般人群的预期相似。虽然这是一项伟大成就，但非传染性疾病 心血管疾病（CVD）等疾病目前在发病率和死亡率中占很大比例 感染者。高血压药物依从性差与血压 (BP) 失控和血压升高有关 心血管疾病事件（如心肌梗塞）的风险。尽管存在这种风险，但 PLWH 的药物依从性研究仍在继续 主要关注 ART，对其他慢性合并症的坚持程度有限。 药物依从性是一种复杂的健康行为，是由多种因素共同驱动的 微观和宏观层面。随着感染艾滋病毒的人变老，他们的需求不仅仅只是管理艾滋病毒 药物依从性，包括对其他病症及其药物的管理。增加药丸负担 艾滋病毒感染者 (OALWH) 老年人面临高血压，加上认知功能下降， 前往机构补充药物的交通和缺乏社会支持会恶化依从性。差异在于 特别是在中低收入国家，抗逆转录病毒治疗是免费的，而高血压药物不是免费的，因此更广泛的不良反应概况 高血压药物以及高血压护理中缺乏复方药也可能导致不依从。坚持支持 针对这些因素的 OALWH 和 HTN 可能有助于提高药物依从性并减少 CVD 事件。 在此 K43 申请中，申请人提出了一项培训计划，使她能够获得以下方面的技能和专业知识： 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具体目标： 共同设计一部小说 CHV 主导的 OALWH 药物依从性支持（CBA 干预）模型，采用以人为本的方法 设计方法（目标 1）；开展 CBA 干预试点并评估其可行性（目标 2）；和行为 CBA 干预的成本核算和预算影响分析（目标 3）。拟议的K43职业发展 包括拟议研究成果在内的活动将最终使我过渡到独立 研究员（R01 资助），在艾滋病毒和老龄化领域做出贡献。