Integrating Hypertension and Cardiovascular Disease Care into Existing HIV Service Package in Botswana (InterCARE)

将高血压和心血管疾病护理纳入博茨瓦纳现有的艾滋病毒服务计划 (InterCARE)

基本信息

批准号：
10261578
负责人：
Tendani Gaolathe
金额：
$ 67万
依托单位：
UNIVERSITY OF BOTSWANA
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-15 至 2022-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10261578
关键词：
AIDS prevention Address Adoption Adult Antihypertensive Agents Attitude Awareness Blood Pressure Botswana Cardiovascular Diseases Cardiovascular system Caring Centers for Disease Control and Prevention (U.S.)Certification Chronic Kidney Failure Clinic Cluster randomized trial Communities Consolidated Framework for Implementation Research Continuity of Patient Care Data Development Diabetes Mellitus Diagnosis Disease Documentation Drug Prescriptions Effectiveness Electronic Health Record Evidence based intervention Funding Funding Mechanisms Guidelines HIV HIV diagnosis HIV prevention trial Health Health Personnel Hybrids Hypertension Incidence Infrastructure Intervention Interview Knowledge Maintenance Methods Myocardial Infarction Patients Perception Pharmaceutical Preparations Polypharmacy Population Prevention Prevention Measures Provider Quality of Care Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Readiness Recommendation Research Research Design Risk Risk Factors Rural Services Site Stroke Surveys Testing Training United States National Institutes of Health Viral base blood pressure regulation cardiovascular risk factor contextual factors design dual diagnosis effectiveness implementation study evidence base health care availability hybrid type 2 design hypertension control implementation framework implementation intervention implementation measures implementation outcomes implementation research implementation strategy improved low and middle-income countries multi-component intervention operation patient health information peri-urban programs social stigma success therapy design uptake

项目摘要

PROJECT SUMMARY An estimated 26% of people living with HIV (PLWHIV) in Botswana have hypertension. Uncontrolled hypertension will add to the already increased risk for cardiovascular (CVD) disease in this population. A hypertension study nested within an HIV prevention trial (Botswana Combination Prevention Project- BCPP), the hypertension continuum of care was suboptimal among PLWHIV; 46% aware of their hypertension, 42% on medication, 44% of those on medication at recommended blood pressure target, with an overall hypertension control of 19%. These data highlight multiple implementation gaps in our setting among PLWHIV for hypertension control and the missed opportunity to address CVD risk factors among those with hypertension. These gaps occur despite national guidelines recommendations, free universal healthcare, availability of needed medications and approaches which can improve quality including training, coaching, and the use of electronic health records (EHR) reminders. Implementation research is urgently needed to develop more effective strategies to improve the uptake of established effective hypertension and CVDRF management interventions among PLWHIV in Botswana and other low- and middle-income countries (LMICs). We propose the adaptation and testing of strategies to effectively integrate evidence- based interventions (EBI) into HIV care to improve hypertension cascade of care (awareness, diagnosis, treatment, control) and general CVD risk factor knowledge, diagnosis and treatment using a late-stage T4 implementation research hybrid type 2 study design. First, we will develop a set of implementation strategies for integrated HIV-HTN/CVD care within an existing HIV care platform for adults with HIV and hypertension and pilot test (2 HIV Clinics) to explore implementation outcomes using RE-AIM framework to inform adaptation for broader testing. We will use the knowledge gained from the development and piloting of the implementation strategy to then use a type 2 hybrid design to measure the implementation outcomes of multi-component strategy in improving EBI uptake and improvement success rates in the HTN cascade among adults with a dual diagnosis of HIV and Hypertension. To achieve this second aim, we are proposing a type 2 hybrid effectiveness-implementation of a 10-cluster randomized trial (1:1 randomization at the facility level) of 300 adults per cluster between 20- 75 years old with a dual diagnosis of HIV and hypertension (>140/90mmHg, >130/80mmHg if living with Diabetes mellitus/Chronic Kidney Disease) in Botswana. Our primary quantitative implementation outcomes based on the RE-AIM framework implementation are reach (proportion of PLWHIV on treatment among those who meet threshold for anti-hypertensive medication), effectiveness (proportion with controlled blood pressure), plus adoption (proportion of providers who screen PLWHIV for high blood pressure plus proportion of providers who prescribe anti-hypertensive medications). Our co-primary qualitative implementation outcomes will include assessment of fidelity (audit of intervention implementation as designed) and maintenance (provider and patient perceptions of ability to maintain plus change in blood pressure control from first control to end of the trial). Our secondary implementation outcomes, we will include assessment of feasibility (ability to implement integrated HIV/HTN care, HIV/HTN/CVD care, clinic viral suppression, etc.) and acceptability (patient and provider survey and interviews) of the implementation strategy.

项目概要据估计，博茨瓦纳 26% 的艾滋病毒感染者 (PLWHIV) 患有高血压。不受控制高血压将增加该人群罹患心血管 (CVD) 疾病的风险。一个高血压研究嵌套在艾滋病毒预防试验中（博茨瓦纳联合预防项目- BCPP），艾滋病毒感染者（PLWHIV）患者的高血压连续治疗效果不佳； 46% 的人意识到自己高血压，42% 的人正在接受药物治疗，其中 44% 的人正在按推荐血压目标服用药物，其中高血压总体控制率为19%。这些数据凸显了我们环境中的多个实施差距 PLWHIV 人群中控制高血压的机会以及错失解决 CVD 危险因素的机会患有高血压的人。尽管有国家指导方针的建议、免费普遍的建议，但这些差距仍然存在医疗保健、所需药物的可用性以及可以提高质量的方法，包括培训，指导以及使用电子健康记录 (EHR) 提醒。实施研究刻不容缓需要制定更有效的策略来提高已确定有效高血压的吸收率博茨瓦纳和其他低收入和中等收入国家的 PLWHIV 和 CVDRF 管理干预措施国家（中低收入国家）。我们建议调整和测试策略以有效整合证据- 基于艾滋病毒护理的干预措施（EBI），以改善高血压护理级联（意识、诊断、治疗、控制）和一般 CVD 危险因素知识、使用晚期 T4 的诊断和治疗实施研究混合类型 2 研究设计。首先，我们将制定一套实施方案在成人艾滋病毒感染者的现有艾滋病毒护理平台内进行综合艾滋病毒-高血压/心血管疾病护理的策略高血压和试点测试（2 个 HIV 诊所），以探索使用 RE-AIM 的实施结果为更广泛测试的适应提供信息的框架。我们将利用从中获得的知识制定和试点实施策略，然后使用 2 类混合设计来衡量多成分战略在提高 EBI 利用率方面的实施成果以及双重诊断为 HIV 和 HIV 的成人中 HTN 级联的成功率提高高血压。为了实现第二个目标，我们提出了一种 2 类混合有效性实施方案一项 10 组随机试验（机构级别 1:1 随机化），每组 300 名成人，年龄介于 20- 75 岁，双重诊断患有艾滋病毒和高血压（>140/90mmHg，如果患有艾滋病，则>130/80mmHg 博茨瓦纳的糖尿病/慢性肾病。我们的主要量化实施基于 RE-AIM 框架实施的结果已经达到（艾滋病毒感染者接受治疗的比例）在达到抗高血压药物阈值的人群中）、有效性（服用抗高血压药物的比例）控制血压），加上采用率（对 PLWHIV 进行高血压筛查的提供者比例）压力加上开抗高血压药物的提供者比例）。我们的共同小学定性实施结果将包括忠诚度评估（干预审计按设计实施）和维护（提供者和患者对维护能力的看法）从第一次控制到试验结束时血压控制的变化）。我们的二次实现结果，我们将包括可行性评估（实施综合 HIV/HTN 护理的能力， HIV/HTN/CVD 护理、临床病毒抑制等）和可接受性（患者和提供者调查和访谈）实施策略。