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Managing multimorbidity together: relationship dynamics and dual medication adherence for hypertension and HIV in
Amy A Conroy1, Julie T Bidwell2, Allison Ruark3
1Department of Medicine, University of California San Francisco, San Francisco, CA, 94158, United States.
Insights
Relationship quality and partner support are crucial for medication adherence in people with HIV and hypertension. Lower adherence is linked to poor relationship dynamics and intimate partner violence, highlighting the need for couple-based interventions.
Area of Science:
- Public Health
- Cardiology
- Infectious Diseases
Background:
- Cardiometabolic disorders, including hypertension (HTN), are common in people with HIV.
- Managing multiple chronic conditions complicates medication adherence.
- Primary partners play a vital role in supporting antiretroviral therapy (ART) but their role in comorbidity management is understudied.
Purpose of the Study:
- To investigate the association between relationship dynamics and dual medication adherence for HIV and HTN.
- Utilized baseline data from the Healthy Hearts cohort study in Malawi.
Main Methods:
- Observational cohort study of people with HIV and HTN and their primary partners.
- Assessed medication adherence, relationship quality (closeness, intimate partner violence [IPV]), shared illness appraisal, and communal coping.
- Used multinomial regression to analyze associations between relationship variables and dual medication adherence.
Main Results:
- Lower adherence to HIV and/or HTN medications was associated with lower relationship closeness, shared illness appraisal, couple communication, and partner support.
- Higher rates of physical, sexual, and emotional IPV were linked to incomplete HIV/optimal HTN adherence.
- Reduced communication and partner support correlated with complete HIV/suboptimal HTN adherence.
Conclusions:
- Poor relationship quality and functioning, including IPV, are associated with lower dual medication adherence.
- Couple-based interventions are recommended to improve adherence by addressing relationship dynamics, communication, and social support.
- Mitigating IPV is essential for successful management of co-occurring HIV and cardiometabolic conditions.
Background:
Cardiometabolic disorders are highly prevalent among people living with HIV, complicating the medication management of both conditions. Primary partners provide key sources of support for antiretroviral therapy; however, little research has considered their role in the context of comorbidities.
Purpose:
Using baseline data from the Healthy Hearts cohort study, we investigated associations between relationship dynamics and dual medication adherence for HIV and hypertension (HTN) in Malawi.
Methods:
Healthy Hearts is an observational cohort study with people living with HIV and either HTN or diabetes and their primary partners. Study assessments occur at baseline, 4, 8, and 12 months. We examined baseline data from participants with HIV and HTN on their adherence to medications, relationship quality (eg, closeness, intimate partner violence [IPV]), shared illness appraisal, and communal coping (eg, partner support, illness communication). Our outcome variable was a composite measure consisting of 4 categories: complete HIV/optimal HTN adherence (reference category), incomplete HIV/suboptimal HTN adherence, incomplete HIV/optimal HTN adherence, and complete HIV/suboptimal HTN adherence. Multinomial regression models tested for associations between relationship variables with dual medication adherence, controlling for covariates.
Results:
Participants with HIV and HTN (N = 228) were split evenly on gender, 53 years on average, and most had a primary school education or less (70%). Compared to the group with higher HIV/HTN adherence, the odds of reporting incomplete HIV/suboptimal HTN adherence were associated with lower closeness, shared illness appraisal, couple communication, and partner support. Similar patterns were found for the incomplete HIV/optimal HTN adherence group, which was also associated with higher physical, sexual, and emotional IPV as compared to those in the reference group. Lower communication and partner support were associated with being in the complete HIV/suboptimal HTN adherence group.
Conclusions:
Lower HIV or HTN adherence (or both) was associated with lower relationship quality and functioning, and IPV. Successful approaches that involve primary partners in disease management for HIV should be extended for cardiometabolic conditions such as HTN. The role of primary partners may be even more important in helping people successfully manage multiple competing health priorities such as HIV and HTN. Couple-based interventions should target dyadic processes such as relationship quality, illness communication, and disease-specific social support while also mitigating the potential harms of IPV on adherence.
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