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Relationship dynamics and spousal support are important for the medical management of single diseases such as HIV, yet little is known about how couples manage the complexity of multiple competing health conditions and their synergistic effects on health. The <jats:italic>Healthy Hearts<\/jats:italic> study aimed to develop a conceptual model of dyadic management of HIV and CMDs, inform interventions for couples in Sub-Saharan Africa, and ultimately improve clinical practice and disease management for HIV and CMD comorbidities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>This study will enrol 250 couples who have at least one partner living with HIV and CMD (either hypertension or diabetes) for a prospective observational cohort study. Patients will be recruited from HIV and CMD clinics in Zomba and Blantyre, Malawi. Couples will attend four study visits at quarterly intervals over 12 months. Both partners are given interviewer-administered surveys and complete a clinical assessment. Regression techniques will be used to test associations between key constructs in our conceptual model, including communal coping, multimorbidity illness perceptions, relationship quality, psychosocial health, disease management (eg, adherence to lifestyle advice and medications) and disease outcomes (eg, viral suppression and CMD control). Findings will be used to identify elements to target in a couple-based intervention for CMD and HIV.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>This study was approved by the University of California, San Francisco (HRPP (Human Research Protection Program); Protocol number 20\u201332126), and the National Health Sciences Research Committee of Malawi (Protocol number 21\/04\/2677). The results will be disseminated at local community meetings and conferences focused on relationships, CMDs and HIV and published in scientific journals.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-102236","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T04:40:43Z","timestamp":1757652043000},"page":"e102236","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Study protocol for healthy hearts: a prospective observational cohort study on dyadic management of HIV and cardiometabolic comorbidities in couples from Malawi"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0609-5077","authenticated-orcid":false,"given":"Amy A","family":"Conroy","sequence":"first","affiliation":[{"name":"Department of Medicine, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie T","family":"Bidwell","sequence":"additional","affiliation":[{"name":"University of California Davis Betty Irene Moore School of Nursing, Sacramento, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5131-1568","authenticated-orcid":false,"given":"Allison","family":"Ruark","sequence":"additional","affiliation":[{"name":"Health Professions, Wheaton College, Wheaton, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torsten B","family":"Neilands","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7807-4072","authenticated-orcid":false,"given":"Sheri D","family":"Weiser","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita M","family":"Butterfield","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Mulauzi","sequence":"additional","affiliation":[{"name":"Invest in Knowledge, Zomba, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Mkandawire","sequence":"additional","affiliation":[{"name":"Invest in Knowledge, Zomba, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"2025091121403275000_15.9.e102236.1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.107.093336"},{"key":"2025091121403275000_15.9.e102236.2","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-016-1423-9"},{"key":"2025091121403275000_15.9.e102236.3","unstructured":"World Health Organization . 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