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

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.