ArticleResearch square2026
Managing Blood Pressure Beyond Viral Suppression for Patient and Provider Perspectives on Antihypertensive Medication Adherence in HIV Care: A Qualitative Study.
Article in Research square, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Background: Hypertension is a leading contributor to cardiovascular disease morbidity among people with HIV (PWH), yet adherence to antihypertensive medications remains suboptimal. While HIV care has achieved high levels of medication adherence through structured monitoring and communication, less is known about how PWH and HIV providers perceive barriers and possible interventions to antihypertensive adherence within HIV care settings. Methods: Semi-structured interviews were conducted with 20 virally suppressed PWH diagnosed with hypertension and 19 HIV providers between August 2022 and February 2024. Interviews explored experiences and perceptions related to antihypertensive medication adherence. Data were analyzed using a rapid qualitative approach with matrix-based techniques and mapped to the Capability, Opportunity, and Motivation (COM-B) behavior change framework. Results: PWH and HIV providers identified overlapping barriers to antihypertensive adherence spanning all COM-B domains. Shared motivational barriers included concerns about side effects, pill burden, and low perceived urgency of hypertension. Opportunity-related barriers included competing life demands and limited visibility of nonadherence due to blood pressure variability. Capability-related challenges centered on difficulty communicating and understanding long-term hypertension risk compared with HIV. Divergence of perspectives emerged around communication, with PWH frequently describing misunderstandings about instructions and intentional non-disclosure of nonadherence, whereas HIV providers emphasized limited capacity to manage non-HIV conditions. Conclusions: Antihypertensive medication nonadherence among PWH reflects patient-, provider-, and system-level challenges that are not fully addressed within HIV care. Extending the strengths of HIV care through structured communication, monitoring, and care delivery offers a practical pathway to improving cardiovascular outcomes among PWH.
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