https://orcid.org/0000-0002-6131-9141
Abstract
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.
Data Sharing Statement
Corresponding author has access to the data and is able to provide them upon request.
Acknowledgments
We would like to thank the study participants for their time and willingness to provide this information.
Disclosure
Dr. Bosworth reports research grants from Sanofi, Novo Nordisk, and Improved Patient Outcomes, Otsuka as well as consulting from Novartis, Abbott, and Sanofi; also personal fees from Preventric Diagnostics outside the submitted work. Dr. Longenecker reports research grants from Gilead Sciences and served on an advisory board for Esperion Therapeutics and grants from Medtronic Philanthropy, outside the submitted work. Dr Kelley Jones reports grants from National Institutes of Health, during the conduct of the study. The remaining authors declare that they have no conflicts or competing interests.