Muiruri Charles, Sico Isabelle P, Schexnayder Julie, Webel Allison R, Okeke Nwora Lance, Longenecker Christopher T, Gonzalez Juan Marcos, Jones Kelley A, Gonzales Sarah E, Bosworth Hayden B
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
Duke Global Health Institute, Duke University, Durham, NC, USA.
Patient Prefer Adherence. 2020 Jun 16;14:985-994. doi: 10.2147/PPA.S254882. eCollection 2020.
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.
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.
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.
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.
在实现病毒抑制后，对于感染艾滋病毒的人（PLWH）来说，关注预防非艾滋病合并症（如心血管疾病，CVD）至关重要，以便提高他们的生活质量和寿命。尽管与未感染艾滋病毒的个体相比，PLWH患CVD的风险更高，但PLWH往往未达到基于证据的CVD预防治疗目标；人们对PLWH未达到指南建议的原因了解甚少。本研究的目的是确定与已实现病毒抑制的PLWH坚持服用CVD药物相关的因素。
定性数据来自于在美国三个大型学术医疗中心进行的形成性研究，该研究旨在为一项由护士主导的干预试验的调整提供信息，以改善心血管健康。使用基于扎根理论的原则指导的内容分析法对转录本进行分析。
51名已实现病毒抑制（<200拷贝/毫升）的个体参与了研究：37人参加了6个焦点小组，14人参加了个人半结构化访谈。平均年龄为57岁（标准差：7.8）；大多数是非洲裔美国人（n = 31），大多数是男性（n = 34）。观察到三个主要主题。首先，参与者报告称，他们的医疗保健提供者的建议与他们自己首选的降低CVD风险的策略不一致。其次，参与者有意改变CVD药物的服用频率，这似乎与低CVD风险认知以及治疗中感知到或经历过的副作用有关。最后，参与者讨论了长期接受艾滋病毒护理的经历对坚持服用CVD药物的影响以及增强坚持心脏健康行为的动机因素。
研究结果表明，未来的研究应侧重于开发干预措施，以加强患者与提供者之间的沟通，从而引出对CVD预防策略的信念、担忧和偏好。未来的研究应寻求利用和调整艾滋病毒护理中既定的循证实践，以支持CVD药物的依从性。
