Profiles of composite medication adherence trajectories in older patients with HIV and multiple chronic conditions: a mixed methods study

The National Institute of Mental Health awarded Kaiser Foundation Hospitals $418,224 on March 1, 2026, under the Mental Health Research Grants program (CFDA 93.242) to conduct a mixed-methods study identifying medication adherence trajectory profiles in older patients living with HIV and multiple chronic conditions.

The research applies group-based trajectory modeling to medication refill data spanning a 36-month observation period in patients aged 50–99 years, followed by 75 semi-structured interviews to identify clinical, social, behavioral, cultural, structural, and economic factors influencing medication adherence decisions in people living with HIV (PLWH) and multiple chronic conditions (MCCs)—including type 2 diabetes, hypertension, and hyperlipidemia. The study aims to develop a taxonomy of distinct medication adherence trajectory types that will inform future intervention development and clinical decision support strategies tailored to older PLWH with MCCs.

Kaiser Foundation Research Institute, the research division of Kaiser Permanente, is conducting the work as principal recipient with performance in Washington, DC. The project period runs through February 29, 2028.

Sub-recipients include Drake University (sub-award R21MH139405-RNG214124-KPMAS02, awarded June 18, 2026) and Touro University College of Osteopathic Medicine (sub-award R21MH139405-RNG214124-KPMSA01, awarded June 8, 2026), each contributing qualitative research expertise through semi-structured interviews, thematic coding, and data analysis aligned with the study's aims. Both sub-recipients will conduct interviews using video-conference technology, apply behavioral theories to interview design, and participate in interpretation and manuscript preparation under the direction of Kaiser Permanente's principal investigator and biostatistician.

Abstract

As life expectancy increases in people living with HIV (plwh), the probability of developing other chronic conditions such as type 2 diabetes (T2DM), hypertension, and cardiovascular disease also increases. Plwh live longer, develop multiple chronic conditions (mccs), and experience polypharmacy, reinforcing a need to evaluate composite medication adherence across all chronic medications. Suboptimal medication adherence to essential treatments may limit treatment effectiveness, shorten survival, decrease overall population health, and increase health-system costs. Positioned at the nexus of therapeutic intent and success, medication adherence is influenced by myriad system, provider, and person-related factors that cannot be evaluated using claims-based studies alone. Therefore, the overarching goal of this research is to identify a taxonomy of composite medication adherence trajectories (mats) over a 36-month observation period in older (50-99 years of age) plwh and mccs. The taxonomies will inform future research involving development and testing of comprehensive medication adherence interventions and clinical decision support strategies with the highest probability to positively impact medication adherence-related clinical outcomes in older plwh and mccs. We propose a mixed-methods explanatory sequential design by combining group-based trajectory modeling (gbtm) of medication refill data followed by 75 semi-structured interviews to fully understand the clinical, social, behavioral, cultural, structural, and economic perspectives that may influence medication adherence decision-making in plwh and mccs (i.e., T2DM, hypertension, and/or hyperlipidemia). We propose the following aims: 1. Apply group-based trajectory modeling of medication refill data to identify dynamic profiles of medication adherence behavior over time for older plwh and mccs. 2. Use qualitative, semi-structured interviews of older plwh and mccs to obtain in-depth understanding of social, behavioral, cultural, structural, and economic perspectives that align with each mat profile. In contrast to disease-specific (intra-disease), dichotomous summary measures focused on antiretroviral therapy alone, this study uniquely identifies longitudinal mats across mccs (inter-disease). Qualitative assessment of lived medication use experiences and array of social, behavioral, cultural, structural, and economic perspectives contributing to mat profiles advances understanding of needs for plwh and mccs to inform optimal, tailored interventions for unique mats unachievable with claims-only studies.