Illness Perceptions, Medication Beliefs, and Adherence to Antiretrovirals and Medications for Comorbidities in Adults With HIV Infection and Hypertension or Chronic Kidney Disease

Weiss, Jeffrey J.; Konstantinidis, Ioannis; Boueilh, Anna; Fierer, Daniel S.; Gardenier, Donald; Barber, Mark G.; Kang, Tony; Kress, Anna; Ericson, Katherine; Lira, Marlene C.; Yostos, Marina; Bogner, Hillary R.; Wisnivesky, Juan P.; Wyatt, Christina M.

doi:10.1097/qai.0000000000001075

Cited by 15 publications

(11 citation statements)

References 33 publications

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“…In order to design interventions that address challenges unique to this patient population, it is crucial to understand the experiences of PLHIV who have navigated hypertension treatment. However, other than a few studies [18][19][20][21][22], the barriers to hypertension awareness, treatment and control among HIV-infected adults in SSA remain largely unexplored. To better understand barriers to hypertension management among PLHIV, we conducted a qualitative study exploring the perspectives and experiences of patients with both HIV and hypertension in northern Tanzania.…”

Section: Introductionmentioning

confidence: 99%

“It’s because I think too much”: Perspectives and experiences of adults with hypertension engaged in HIV care in northern Tanzania

et al. 2020

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Background Hypertension, a leading risk for cardiovascular mortality, is an important co-morbidity among people living with HIV (PLHIV). In Tanzania, hypertension prevalence among PLHIV approaches 20 to 30%. However, most patients are unaware of their diagnosis and are not receiving treatment. Understanding the barriers to hypertension care is a critical first step in developing interventions to improve cardiovascular outcomes among PLHIV in Tanzania and similar settings. Methods Between September 1st and November 26th, 2018 thirteen semi structured in-depth interviews were conducted with hypertensive patients engaged in HIV care in two HIV clinics located in government health facilities in northern Tanzania. Interviews were audio-recorded, translated into English, transcribed and thematically coded using NVivo. Data analysis was conducted using applied thematic analysis. Results Participants had a median age of 54 (IQR 41–65) years. Of the 13 participants, eight stated they had used antihypertensive medication previously, but only one participant described current use of antihypertensive therapy. All participants were currently using antiretroviral therapy. The data revealed a range of themes including limited hypertension knowledge. Universally, all participants believed that “thinking too much”, i.e. stress, was the major contributor to hypertension and that by “reducing thoughts”, one may control hypertension. Additional emerging themes included a perceived overlap between hypertension and HIV, delays in hypertension diagnosis and linkage to care, challenges with provider communication and counseling, reluctance towards antihypertensive medication, lack of integration of hypertension and HIV care, and additional structural barriers to hypertension care. Conclusions Participants described multiple, intersecting challenges related to hypertension management. Barriers specific to PLHIV included siloed care, HIV-related stigma, and burden from multiple medical conditions. Multifaceted strategies that seek to address structural barriers, hypertension education, psychosocial stressors and stigma, and that are integrated within HIV care are urgently needed to improve cardiovascular outcomes among PLHIV in sub-Saharan Africa.

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Section: Introductionmentioning

confidence: 99%

“It’s because I think too much”: Perspectives and experiences of adults with hypertension engaged in HIV care in northern Tanzania

et al. 2020

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“…15,16 In two other studies significant differences between rates for ART and hypertension, chronic kidney disease, or diabetes medications were not observed. 17,18 Barriers to CVD medication adherence for PLWH who are adherent to ART may be different than for PLWH who are nonadherent to ART. It is therefore important to study these groups independently.…”

Section: Introductionmentioning

confidence: 99%

<p>Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry</p>

Muiruri¹,

Sico²,

Schexnayder³

et al. 2020

PPA

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Background: After achieving viral suppression, it is critical for persons living with HIV (PLWH) to focus on prevention of non-AIDS comorbidities such as cardiovascular disease (CVD) in order to enhance their quality of life and longevity of life. Despite PLWH elevated risk of developing CVD compared to individuals without HIV, PLWH do not often meet evidence-based treatment goals for CVD prevention; the reasons for PLWH not meeting guideline recommendations are poorly understood. The objective of this study was to identify the factors associated with adherence to CVD medications for PLWH who have achieved viral suppression. Methods: Qualitative data were obtained from formative research conducted to inform the adaptation of a nurse-led intervention trial to improve cardiovascular health at three large academic medical centers in the United States. Transcripts were analyzed using content analysis guided by principles drawn from grounded theory. Results: Fifty-one individuals who had achieved viral suppression (<200 copies/mL) participated: 37 in 6 focus groups and 14 in individual semi-structured interviews. Mean age was 57 years (SD: 7.8); most were African Americans (n=31) and majority were male (n=34). Three main themes were observed. First, participants reported discordance between their healthcare providers' recommendations and their own preferred strategies to reduce CVD risk. Second, participants intentionally modified frequency of CVD medication taking which appeared to be related to low CVD risk perception and perceived or experienced side effects with treatment. Finally, participants discussed the impact of long-term experience with HIV care on adherence to CVD medication and motivational factors that enhanced adherence to heart healthy behaviors. Conclusion: Findings suggest that future research should focus on developing interventions to enhance patient-provider communication in order to elicit beliefs, concerns and preferences for CVD prevention strategies. Future research should seek to leverage and adapt established evidence-based practices in HIV care to support CVD medication adherence.

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“…An important cause of poor BP control is poor adherence to antihypertensive drugs 16 which could be due to a myriad of reasons. In PLWHV, management of comorbidities is often relegated 17 ; antiretroviral medications are usually regarded as being more important than medications for hypertension, resulting in better adherence to the former 12,18,19 . Furthermore, the potential for drug‐drug interaction is higher in multimorbidity 20,21 ; such interactions have been adduced to explain clinical failure of antiretroviral therapy 21 .…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…Through PC, the pharmacist is able to improve health outcomes by reinforcing messages regarding the importance of achieving treatment goals, education about drug therapies, effective lifestyle modifications and treatment adherence 7 . Previous studies have focused on PC in either HIV 24–26 or hypertension, 27,28 or assessed differential clinical outcomes in HIV‐hypertension comorbidity 12,17,18,29,30 . However, none, to the best of our knowledge has evaluated the impact of PC in such comorbidity.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Clinical outcomes of pharmaceutical care intervention in HIV positive patients with hypertension: A randomized controlled study

Jackson

Ukwe

2021

J Clin Pharm Ther

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What is known and objective Pharmaceutical care (PC) has been shown to improve clinical outcomes in hypertensive patients as well as in people living with HIV (PLWHV). The objective of this study was to evaluate the impact of PC on blood pressure (BP) control, viral load and adherence to medications in hypertensive PLWHV. Methods This was a prospective, randomized controlled study conducted in the University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria. Eligible ambulatory patients were randomized equally to two study arms. The control arm (CA) received the traditional care offered at the HIV clinic; the intervention arm (IA) received the traditional care in addition to PC by the research pharmacist, which included structured education/counselling. BP and self‐reported medication adherence were measured at baseline, 6 months and 12 months. Viral load was obtained at baseline and after 12 months. Data were analysed with spss, version 25.0. Results and discussion Of the 206 participants initially randomized, 182 (91 in each study arm) completed the 12‐month follow‐up. No significant differences existed in both arms concerning socio‐demographic/clinical characteristics of participants at baseline (p > 0.05). After 12 months, BP control was significantly higher in the IA (53.4% vs. 25.2%; p < 0.001, adjusted odds ratio, aOR = 3.20 (95% CI 1.59–6.44). Systolic BP reduced by 0.9 mmHg from baseline in the CA (p = 0.668) and by 16.67 mmHg from baseline value in the IA (p < 0.001). Diastolic BP increased by 1.9 mmHg in the CA (p = 0.444), but reduced by 7.0 mmHg in the IA (p < 0.001). No significant differences were observed in the change from baseline in the proportion with undetectable plasma viral load (UPVL) in both groups (p > 0.05). PC led to an increase in mean adherence to antiretroviral drugs (Δ = 0.55; p = 0.015), and an increase in mean adherence to antihypertensive drugs (Δ = 2.32; p < 0.001) in the IA. What is new and conclusion To our knowledge, this is the first prospective randomized controlled study evaluating the impacts of PC on clinical outcomes in hypertensive PLWHV with a 12‐month follow‐up. Our results show that PC significantly improved BP control and adherence to antiretroviral and antihypertensive medications, but had no significant effect on viral load in HIV positive patients with hypertension. Providers of care for PLWHV should leverage the established HIV treatment successes for promoting adherence to treatment for common comorbidities like hypertension in PLWHV in order to improve clinical outcomes.

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Illness Perceptions, Medication Beliefs, and Adherence to Antiretrovirals and Medications for Comorbidities in Adults With HIV Infection and Hypertension or Chronic Kidney Disease

Cited by 15 publications

References 33 publications

“It’s because I think too much”: Perspectives and experiences of adults with hypertension engaged in HIV care in northern Tanzania

“It’s because I think too much”: Perspectives and experiences of adults with hypertension engaged in HIV care in northern Tanzania

<p>Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry</p>

Clinical outcomes of pharmaceutical care intervention in HIV positive patients with hypertension: A randomized controlled study

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