Integrated Community-based Treatment of HIV and Hypertension in Zambia

赞比亚艾滋病毒和高血压的社区综合治疗

• 批准号: 9920767
• 负责人: Monika Roy
• 金额: $ 0.83万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-15 至 2020-05-25
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9920767
• 关键词: AIDS/HIV problem; Acute; Address; Adherence; Adopted; Adoption; Adult; Africa; Africa South of the Sahara; Age; Antihypertensive Agents; Awareness; Biometry; Blood Pressure; Cardiovascular Diseases; Caring; Cessation of life; Chronic; Chronic Disease; Clinic; Clinic Visits; Communities; Data; Data Analyses; Decentralization; Development; Diagnosis; Disease; Disease Management; Effectiveness; Epidemiology; Evaluation; Event; Focus Groups; Foundations; Future; Goals; Group Meetings; HIV; HIV Seropositivity; Health; Health Personnel; Health Services Accessibility; Health system; Healthcare; Hypertension; Improve Access; Incidence; Individual; International; Interview; Investments; K-Series Research Career Programs; Knowledge; Maintenance; Measures; Mentors; Mentorship; Modeling; Monitor; Patients; Persons; Pharmaceutical Preparations; Policies; Population; Positioning Attribute; Provider; Public Health; Qualitative Methods; Qualitative Research; Randomized; Research; Research Design; Research Methodology; Research Personnel; Resources; Risk; Risk Factors; Self Management; Services; Social support; Structure; Testing; Time; Training; Transportation; Wait Time; Zambia; analytical method; antiretroviral therapy; base; blood pressure reduction; blood pressure regulation; cardiovascular disorder epidemiology; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular risk factor; care delivery; career; career development; community based treatment; cost; design; effectiveness evaluation; experience; hypertension control; hypertension treatment; implementation research; implementation science; improved; innovation; member; modifiable risk; novel strategies; opportunity cost; overtreatment; preservation; response; retention rate; scale up; theories; uptake

ABSTRACT An estimated 10-30% of the 21.8 million HIV-infected adults in sub-Saharan Africa have hypertension, the single largest risk factor for cardiovascular disease (CVD). The consequences of untreated hypertension are magnified in HIV-infected individuals who are at 50% greater risk of experiencing a CVD event than HIV- uninfected persons, even after controlling for traditional CVD risk factors. Although the scale up of HIV treatment means that millions of patients are now in contact with the health system, poor uptake of hypertension treatment in these same populations persists. As a result, fewer than 10% of hypertensive patients on HIV treatment have controlled blood pressure. Because HIV and hypertension management share many barriers (e.g., opportunity costs of accessing care), emerging solutions for HIV treatment also represent critical opportunities to improve access to, and sustainability of, treatment for other chronic conditions in Africa. The proposed K23 study seeks to understand the implementability and effects of adding hypertension treatment into the “community adherence group” (CAG) model for HIV treatment in Zambia. In Aim 1, we will evaluate the implementation of the hypertension care into this model by measuring adoption, fidelity of implementation, and sustainability of access to hypertension medications over time. In Aim 2, we will use a before-and-after design to evaluate the effectiveness of introduced practices on blood pressure. In Aim 3, we will use in-depth interviews and focus groups among both health care workers and patients to understand how to optimize the acceptability, fit, and reach of the model for future dissemination and eventual extension into HIV-uninfected populations with hypertension. I am currently immersed in a project supported by the Bill and Melinda Gates Foundation that seeks to implement and scale up the CAG model for HIV treatment in Zambia. My hands-on knowledge of CAG implementation will make the addition of a hypertension component into the CAG model immediately feasible. Findings from the scientific aims proposed will inform an R01 evaluating the dissemination of an integrated HIV and hypertension treatment CAG model and an R21 to expand the model to HIV-uninfected patients. The overarching goal of this proposed mentored career development award is to support my development into an independent implementation science researcher with a focus on health systems innovations for chronic diseases in resource-limited settings. The career development aims for this K23 are to obtain expertise in (1) the application of implementation science theory to research design and evaluation; (2) analytic methods for correlated and longitudinal data; (3) the use of qualitative methods in implementation research and (4) positioning research questions and findings to optimize influence on practice and policy. This plan will be carried out with coursework and guidance of an international team of mentors with expertise in HIV & cardiovascular disease epidemiology, implementation science, biostatistics, and mixed methods research.

抽象的 估计在撒哈拉以南非洲的2180万艾滋病毒成年人中估计10-30％ 心血管疾病的最大危险因素（CVD）。 在艾滋病毒感染的个体中放大了比艾滋病毒高50％的CVD事件风险 即使控制传统的CVD危险因素，未感染的人也是如此。 治疗意味着数以百万计的患者现在与卫生系统接触 相同人群中的高血压治疗持续存在。 HIV治疗的患者患有血压。 许多障碍（例如，获得护理的机会统一成本），HIB治疗的新兴解决方案也压制 提高非洲其他慢性病的治疗方法和可持续性的关键机会。 拟议的K23研究旨在了解增加高压的实施性和影响 在AIM 1中的“社区依从组”（CAG）模型。 通过测量采用，保真度，评估高血压护理中的高血压护理 随着时间的时间2，我们将使用一种使用高血压药物的可持续性，我们将使用 在AIM 3中引入练习的有效性，我们在AIM 3中的有效性。 将使用深入的访谈并专注于两位医疗保健工作者，以了解如何了解如何了解 为了优化模型的可接受性，适合和范围，以使将来的文化和最终扩展到 艾滋病毒未侵蚀的人群患有高血压。 梅琳达·盖茨基金会（Melinda Gates Foundation）试图在赞比亚实施和扩展艾滋病毒治疗的CAG模型。 我对CAG实施的实践知识将增加 CAG模型是可行的。 传播综合艾滋病毒和高血压治疗CAG模型和R21，以将模型扩展到 艾滋病毒未感染的贴。 支撑指导的职业发展的总体目标是支持我的发展 独立实施科学研究人员，重点是慢性卫生系统创新 资源有限的设置中的疾病。 实施科学理论在研究设计和评估中的应用； 相关和纵向数据； 定位研究问题和发现以优化实践和政策。 在一支拥有HIB专业知识的国际导师团队的课程和指导下进行的 心血管疾病的流行病学，实施科学，生物统计学和混合方法研究。