PULESA-UGANDA-Strengthening the Blood Pressure Care and Treatment cascade for Ugandans living with HIV-ImpLEmentation Strategies to SAve lives

PULESA-乌干达-加强乌干达艾滋病毒感染者的血压护理和治疗级联实施策略以拯救生命

• 批准号: 10294232
• 负责人: Chris Todd Longenecker
• 金额: $ 74.55万
• 依托单位: INFECTIOUS DISEASES RES COLLABORATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-10 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10294232
• 关键词: AIDS/HIV problem; Address; Adherence; Adoption; Africa South of the Sahara; Antihypertensive Agents; Awareness; Blood; Blood Pressure; Cardiovascular Diseases; Caring; Cessation of life; Chronic; Climate; Clinic; Clinical; Cluster randomized trial; Collaborations; Consolidated Framework for Implementation Research; Coronary; Cost Analysis; Cost Effectiveness Analysis; Cost effectiveness research; Data; Data Set; Development; Diagnosis; Diagnostic Equipment; Economics; Evaluation; Expenditure; Foundations; Goals; Gold; Government; Grant; HIV; HIV Infections; Health; Health Services; Heart; Household; Human; Hybrids; Hypertension; Institution; International; Intervention; Investments; Knowledge; Low-Density Lipoproteins; Measurement; Methods; Modeling; Monitor; Patients; Pharmaceutical Preparations; Plant Roots; Prevention; Process; Randomized; Research Design; Resources; Risk; Service delivery model; Training; Uganda; Update; Use Effectiveness; Variant; Work; antiretroviral therapy; base; cardiovascular disorder risk; cardiovascular risk factor; comorbidity; compare effectiveness; cost; cost effective; cost effectiveness; cost-effectiveness evaluation; data format; design; disability; disability-adjusted life years; economic impact; effectiveness evaluation; effectiveness outcome; effectiveness testing; evidence base; formative assessment; hypertension control; implementation cost; implementation framework; implementation outcomes; implementation science; implementation strategy; improved; incremental cost-effectiveness; innovation; low and middle-income countries; multidisciplinary; peer; peri-urban; preservation; prevent; primary outcome; screening; service delivery; therapy development; treatment as usual; uptake

Project Summary Chronic HIV infection is a well-established risk factor for cardiovascular disease. In sub-Saharan Africa)—a region that may account for half of the global burden of CVD attributable to HIV—hypertension is the most important driver of CVD risk. Profound barriers to effective hypertension management exist, including limited knowledge, inconsistent BP measurement, and poor access to medications. HIV care innovations such as access to no-cost antiretroviral therapy, differentiated service delivery and use of PLHIV peers in care models may improve care of comorbid conditions such as hypertension. The overarching goal of PULESA-UGANDA study is to improve the BP treatment cascade for people living with HIV (PLHIV) in urban and peri-urban Uganda in a scalable and sustainable manner. This hybrid IS Type 3 study proposes to first explore current practice, routines, barriers, and facilitators of evidence–based BP care in HIV clinical settings in Kampala and Wakiso districts (Aim 1). Then, using a human-centered design approach, a design team of key stakeholders will use data from the formative assessment to develop a multi-component implementation strategy (HTN-PLUS) to improve uptake and adherence to evidence-based BP treatments, contextually adapted to these Ugandan HIV clinics (Sub-aim 1.1). The design team will adapt differentiated service delivery models, use of hypertensive PLHIV peer champions, and methods of BP monitoring that address specific barriers and facilitators of BP care. In a stepped-wedge cluster randomized trial of 16 clinics from Kampala and Wakiso, we will determine the effectiveness of implementation strategies to improve BP cascade metrics (Aim 2). Clinics will be randomized to receive free and consistent access to diagnostic equipment and evidence-based antihypertensive drugs (HTN-BASIC) with and without the multi-component implementation strategy developed in sub-aim 1 (HTN-PLUS). The primary effectiveness outcome will be % of patients with hypertension diagnosis who are controlled (<140mmHg systolic). We hypothesize that the HTN-BASIC intervention will increase control from 25% at baseline to 35%, and that HTN-PLUS will further increase control to 40%. We will conduct an extensive mixed-methods process evaluation. We will assess scalability as our main implementation outcome, and will also assess acceptability, adoption, and implementation climate. Finally, we will evaluate the economic and financial sustainability of the integrated care strategies in a cost-effectiveness analysis from a societal perspective that will include household out-of-pocket expenditures. The primary outcome of this aim will be incremental cost per BP- controlled patient. This study will provide much needed evidence to SSA government stakeholders for a strategy to preserve the health gains of HIV treatment by preventing death and disability from CVD. Importantly, it will offer economic evidence of the scalability, sustainability, and equity of a model of HIV- hypertension management integration.

项目摘要 慢性艾滋病毒感染是心血管疾病的公认危险因素。在撒哈拉以南非洲） 可能占CVD全球燃烧的一半的区域，可归因于艾滋病毒 - 高血压是最大的 CVD风险的重要驱动力。存在有效高血压管理的深刻障碍，包括有限 知识，BP测量不一致以及获得药物的机会不佳。艾滋病毒护理创新，例如 在护理模型中使用无成本的抗逆转录病毒疗法，分化的服务提供和使用PLHIV同伴 可以改善对高血压等合并症的护理。 Pulesa-uganda的总体目标 研究是为了改善城市和城市艾滋病毒（PLHIV）患者（PLHIV）的BP治疗级联 乌干达以可扩展和可持续的方式。该混合动力是3型研究建议，首先探索 HIV临床环境中基于证据的BP护理的当前实践，常规，障碍和促进者 在坎帕拉和瓦基索地区（AIM 1）。然后，使用以人为本的设计方法，一个设计团队 主要利益相关者将使用格式评估中的数据来开发多组分 实施策略（HTN-Plus），以改善对基于证据的BP的吸收和遵守 治疗，上下文适应了这些乌干达艾滋病毒诊所（Sub-aim 1.1）。设计团队将适应 差异化的服务交付模型，高血压PLHIV同伴冠军的使用以及BP的方法 监视该问题的特定障碍和BP护理的促进者。在阶梯式北方集群中随机 来自坎帕拉和瓦基索的16个诊所的试验，我们将确定实施的有效性 改善BP级联指标的策略（AIM 2）。诊所将被随机接收免费， 一致使用诊断设备和循证降压药（HTN-BASIC），并与 没有Sub-Aim 1（HTN-Plus）中开发的多组分实现策略。主要 有效性结果将是受控高血压诊断患者的百分比（<140mmHg 收缩期）。我们假设HTN-BASIC干预措施将从基线的25％增加到35％， HTN-Plus将进一步将控制力增加到40％。我们将进行广泛的混合方法 评估。我们将评估可伸缩性作为我们的主要实施结果，还将评估可接受性， 采用和实施气候。最后，我们将评估 从社会角度进行成本效益分析中的综合护理策略，包括 家庭自付支出。这个目标的主要结果是每个bp- 受控患者。这项研究将为SSA政府利益相关者提供急需的证据 通过防止CVD死亡和残疾来维护艾滋病毒治疗的健康益处的策略。 重要的是，它将提供经济证据，证明艾滋病毒模型的可扩展性，可持续性和平等性 高血压管理整合。

项目成果

Economic evaluation of implementation science outcomes in low- and middle-income countries: a scoping review.

• DOI: 10.1186/s13012-022-01248-x
• 发表时间: 2022-11-16
• 期刊: IMPLEMENTATION SCIENCE
• 影响因子: 7.2
• 作者: Malhotra, Akash;Thompson, Ryan R.;Kagoya, Faith;Masiye, Felix;Mbewe, Peter;Mosepele, Mosepele;Phiri, Jane;Sambo, Jairos;Barker, Abigail;Cameron, Drew B.;Davila-Roman, Victor G.;Effah, William;Hutchinson, Brian;Laxy, Michael;Newsome, Brad;Watkins, David;Sohn, Hojoon;Dowdy, David W.
• 通讯作者: Dowdy, David W.