The overarching goal of this K23 proposal is to provide Greer Burkholder, MD, MSPH, with the requisite training for development into an independent clinical investigator. Her focus on outcomes research and interventions to improve prevention and management of cardiovascular disease (CVD) among persons living with HIV is novel and highly topical. Up to 15% of deaths among HIV-infected patients are due to CVD, and they experience increased risk for myocardial infarction and stroke compared to the general population. Research on strategies to manage and prevent CVD is a priority of the NIH/NHLBI AIDS Program. Lowering risk for CVD relies heavily on pharmacotherapy for modifiable conditions such as hypertension, with medication adherence playing a prominent role. However, among HIV-infected patients adherence research has focused almost exclusively on ART, while antihypertensive medication adherence remains largely unstudied. Hypertension is common among HIV-infected patients and many have uncontrolled blood pressure. Formative research is needed to fill knowledge gaps regarding antihypertensive medication adherence and its impact on suboptimal blood pressure control among persons living with HIV. This foundational research is essential to inform interventions targeted toward improving antihypertensive medication adherence and CVD outcomes, in order to further enhance the gains in longevity and quality of life afforded by ART. This K23 is grounded in the information-motivation-behavioral skills (IMB) model, which has been widely used in ART adherence interventions and posits that three factors are required for adherence: 1) information regarding the condition and medications; 2) personal and social motivation; and 3) behavioral skills that enhance adherence. Informed by the IMB framework, this K23 scope of work will utilize quantitative and focus group research on antihypertensive medication adherence among HIV-infected patients to develop and pilot test an intervention to improve adherence and blood pressure control. Research will be conducted within two large, well-established HIV cohorts at the University of Alabama at Birmingham (n=3,028;
Aims 1 and 2) and University of Washington (n=3,863, Aim 1 only). Hypothesis: Suboptimal adherence to antihypertensive medications will be a significant contributor to uncontrolled blood pressure among HIV-infected patients with hypertension, and the information-motivation- behavioral skills (IMB) model will provide an effective framework for evaluating antihypertensive medication adherence and developing an intervention to improve adherence and blood pressure control in this population.
The specific aims are:
Aim 1 : Evaluate the prevalence and correlates of adherence to antihypertensive medications among HIV- infected patients with hypertension and the impact of adherence on blood pressure control through a prospective cohort study at the UAB and UW HIV Clinics (n=400), and through focus group research at UAB.
Aim 2 : Develop and pilot test a tailored intervention to enhance adherence to antihypertensive medications and blood pressure control among HIV-infected patients, informed by the IMB framework and formative research from Aim 1.
These research aims will be complemented by training in advanced quantitative methods, health behavior, and intervention design, conduct, and evaluation under the guidance of expert mentors and advisors. Upon completion of these K23 activities, Dr. Burkholder will be poised to conduct a fully powered randomized controlled trial in the eight-site Center for AIDS Research Network of Integrated Systems (CNICS) cohort supported by an R01 grant, leveraging her training and resources to improve antihypertensive management and treatment outcomes among persons living with HIV.
Cardiovascular disease is a major cause of non-AIDS-related illness and death among persons living with HIV, and they are at higher risk for heart attack and stroke than uninfected persons. Hypertension, a major modifiable risk factor for cardiovascular disease, is common among HIV-infected patients, and nearly half with this condition have uncontrolled blood pressure. The project described in this application will develop and pilot test an intervention to improve adherence to blood pressure medications and blood pressure control among HIV-infected patients with the goal of reducing their risk for cardiovascular disease.
| Muzny, Christina A; Burkholder, Greer A; Fry, Karen R et al. (2016) Trichomonas vaginalis Nucleic Acid Amplification Testing at an Urban HIV Clinic. Sex Transm Dis 43:483-8 |
| Tamhane, Ashutosh R; Westfall, Andrew O; Burkholder, Greer A et al. (2016) Prevalence odds ratio versus prevalence ratio: choice comes with consequences. Stat Med 35:5730-5735 |
