Managing multimorbidity together: relationship dynamics and dual medication adherence for hypertension and HIV in Malawi

Abstract 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.