"HIV has transitioned into a chronic condition often accompanied by multimorbidity, defined as the presence of two or more chronic conditions, creating a growing public health challenge related to complex medication management, treatment burden, and long-term health outcomes. Patients with multimorbidity frequently experience polypharmacy, drug–drug interactions (DDIs), and treatment burden. Treatment burden refers to the workload required to manage health, including medical appointments, diagnostic tests, medication management, lifestyle changes, communication with providers, and navigation of care. High treatment burden may negatively affect medication self-management, quality of life, and engagement in care.
Women, including cisgender and transgender women, living with HIV aged ≥50 years (WLWH50+) in Washington, DC experience a disproportionate burden of multimorbidity, polypharmacy, DDI risk, and treatment burden despite major advances in antiretroviral therapy (ART). In this study, polypharmacy is defined as the use of five or more medications, including ART and medications for comorbid chronic conditions. More than 50% of people living with HIV in Washington, DC are aged 50 years or older, underscoring the urgent need for aging-focused, person-centered HIV interventions. WLWH50+ have unique medication management experiences that warrant focused investigation and are frequently overlooked in research, clinical care, and supportive services.
Existing HIV care and medication management approaches provide limited attention to treatment burden, medication self-management, medication self-efficacy, DDI awareness, and whole-regimen medication navigation among women aging with HIV and multimorbidity. Although HIV-geriatric and integrated chronic disease models may support medication optimization and reduce medication-related risks, they are often resource-intensive and not tailored to the treatment burden, medication complexity, and lived experiences of WLWH50+.
The overall goal of this DC CFAR pilot is to use Human-Centered Design (HCD) to identify medication-related challenges and co-create a nurse-led Medication Empowerment Toolkit for WLWH50+ with multimorbidity and polypharmacy. This project will focus on formative intervention development through two aims: Aim 1 will characterize real-world medication management experiences through journeymapping interviews, and Aim 2 will engage WLWH50+, clinicians, and community partners in co-designing the Medication Empowerment Toolkit. Pilot testing of feasibility, acceptability, usability, and preliminary impact will be deferred to a future NIH R21 application.
HCD is a participatory, iterative approach that engages end users as co-creators to ensure that interventions are relevant, acceptable, and feasible within real-world settings. In this study, HCD will include: Phase 1, Inspiration/data gathering through journey-mapping interviews; Phase 2, Ideation/development through co-design workshops with WLWH50+, clinicians, and community partners; and Phase 3, prototype refinement to produce a patient-centered Toolkit and nurse implementation guide for future testing. The proposed work is also informed by the Geriatrics 5Ms framework, with emphasis on Medications, Mind/self-efficacy, Mobility/access barriers, Multimorbidity, and What Matters Most to each participant.
The Medication Empowerment Toolkit will include patient-facing medication navigation tools and a nurse implementation guide designed to support medication understanding, DDI awareness, medication organization, communication with providers, and self-management of complex treatment regimens. Prototype components may include visual medication sheets, DDI safety cards, medication organization aids, provider communication prompts, and nurse delivered education and support materials. Materials will be developed with attention to health literacy, cultural relevance, privacy, and the daily routines, social responsibilities, cultural context, and competing demands that may shape medication management among WLWH50+.
This pilot is intentionally formative and intervention-development focused. It advances existing nurse-led adherence and medication support research by moving beyond adherence-only models toward patient-centered, whole-regimen medication management grounded in the lived experiences of women living with HIV in Washington, DC. The investigator’s expertise in nursing, pharmacology, HCD, journey mapping, and community-engaged research, combined with longstanding partnerships with community-based organizations in Washington, DC, including The Women’s Collective (TWC), uniquely positions her to lead this work. TWC will support recruitment, participant outreach, trust-building, community engagement, space or virtual support for study activities, and review of culturally responsive study materials. Findings from this pilot will generate a patient-informed Medication Empowerment Toolkit and preliminary formative data to support a future NIH R21 application to test the Toolkit compared with standard care among WLWH50+ with multimorbidity and polypharmacy."
Project Summary provided by investigator.