Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry.



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.





Published Version (Please cite this version)


Publication Info

Muiruri, Charles, Isabelle P Sico, Julie Schexnayder, Allison R Webel, Nwora Lance Okeke, Christopher T Longenecker, Juan Marcos Gonzalez, Kelley A Jones, et al. (2020). Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry. Patient preference and adherence, 14. pp. 985–994. 10.2147/ppa.s254882 Retrieved from https://hdl.handle.net/10161/25534.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



Charles Muiruri

Assistant Professor of Population Health Sciences

Dr. Muiruri is a health services researcher, Assistant Professor in the Duke Department of Population Health Sciences, Assistant Research Professor in the Global Health Institute, and Adjunct lecturer at the Kilimanjaro Christian Medical University College, Moshi Tanzania.
Broadly, his research seeks to improve the quality of healthcare and reduce disparities for persons with multiple chronic conditions both in and outside the United States. His current work focuses on prevention of nonAIDS comorbidities among people living with HIV. His current projects funded by NIAID, NHLBI and NIMHD focus on improving the quality of cardiovascular disease prevention and care among people living with HIV in North Carolina and Tanzania.

Areas of Expertise: Mixed methods, Qualitative methods, Applied Econometrics in Health services Research,  Preference research, Implementation Science, Global Health, Health Policy


Nwora Lance Okeke

Associate Professor of Medicine

Juan Marcos Gonzalez

Associate Professor in Population Health Sciences

Dr. Gonzalez is an Associate Professor in the Department of Population Health Sciences. He is an expert in the design of stated-preference survey instruments and the use of advanced statistical tools to analyze stated-preference data. His research has focused on the transparency in benefit-risk evaluations of medical interventions, and the elicitation of health preferences from multiple stakeholders to support shared decision making.

Dr. Gonzalez co-led the first FDA-sponsored preference study which was highlighted in FDA’s recent precedent-setting guidance for submitting patient-preference evidence to inform regulatory benefit-risk evaluations of new medical devices. More recently, Dr. Gonzalez collaborated with the Medical Devices Innovation Consortium (MDIC) to prepare the first catalog of preference-elicitation methods (part of the Patient-Centered Benefit-Risk Assessment Framework) suitable for benefit-risk assessments of medical devices. As a core group member of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Conjoint Analysis Task Force, Dr. Gonzalez helped draft good-practice recommendations for statistical analysis, interpretation, and reporting of health preference data. Currently, he is working with the Center for Devices and Radiological Health at FDA to support the Center’s capabilities for the review of stated-preference data in regulatory decisions.

Areas of expertise: Clinical Decision Sciences and Health Measurement

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