Integrating HIV and hEART health in South Africa (iHeart-SA)

摘要 我们的多学科、多国实施科学专家团队建议， 评估“在南非整合艾滋病毒和hEART健康”（iHeart-SA）计划， 艾滋病毒感染者的高血压和糖尿病筛查和治疗。SA是 艾滋病毒流行病的中心，全世界有700多万艾滋病毒感染者，其中约500万人接受抗艾滋病毒治疗。 逆转录病毒疗法（ART）。ART的推出有两个相关的影响：首先，PLWH现在大约有 患高血压、糖尿病和心血管疾病（CVD）的风险增加一倍;第二，ART的成功 计划创建了相应的任务，以提供综合，高质量，可持续的治疗策略 在艾滋病护理中检测、治疗和控制HTN和DM。存在患者、提供者和系统级别的障碍， 实现这些目标;但是，也有基于证据的干预措施来解决这些问题，我们有 在南非和印度应用这些方法改变CVD合并症护理的丰富经验。我们 我已经确定了心血管疾病治疗的障碍，并回顾了文献，以选择一揽子干预措施 在随机对照试验中证明是成功的，包括：使用非临床护理协调员来支持 治疗记录和质量改进（QI）;纳入家庭监测，以提高自我 管理;决策支持工具，以促进治疗的启动和修改;和每月审计/ 反馈会议，以支持持续QI。我们将使用EPIS框架并与政府合作， 学术、设施和社区利益相关者通过以下方式指导项目：探索（让利益相关者参与 以人为本的设计，使干预方案与当地的能力、机会和 准备（加强科学执行能力，目标UG 2）; 实施和评估干预方案，通过一个阶梯式楔形群试验，并评估两者 实现（例如，覆盖范围、采用率、保真度）和有效性（例如，控制血压〔主要 结果]之间PLWH和HTN），目标UH 1;衡量24个月后的可持续性和成本（其中12 花了几个月的时间将交付从研究转移到当地工作人员（Aim UH 2）;并制定了一项规模化战略 农村诊所和全国（Aim UH 3）。本项目的总体目标是采用严格的经验主义方法， 开发和测试护理创新的方法，以可持续，可扩展， 有影响力的方式。我们将采用可实现的里程碑计划来提供高质量的产出，包括： 在项目期间继续保持利益攸关方关系和共同拥有研究;完成三个 实施科学博士;通过高影响力的出版物和演讲传播研究结果。 我们还将参加NHLBI的合作多机构网络，旨在加强研究 方法和影响，并促进下一代科学领导人的培训。

ABSTRACT Our multidisciplinary, multi-country team of implementation science experts propose to adapt, implement, and evaluate the “Integrating HIV and hEART health in South Africa” (iHeart-SA) program that incorporates hypertension (HTN) and diabetes (DM) screening and treatment for people living with HIV (PLWH). SA is the epicenter of the HIV pandemic worldwide with over 7 million PLWH, of whom ~5 million are treated with anti- retroviral therapies (ART). ART rollout has two relevant repercussions: first, PLWH now have approximately twice the risk of developing HTN, DM, and cardiovascular disease (CVD); and second, the success of ART programs creates a corresponding mandate to deliver integrated, high-quality, sustainable treatment strategies to detect, treat, and control HTN and DM in HIV care. There are patient-, provider-, and system-level barriers to achieving these goals; but, there are also evidence-based interventions to address them, and we have extensive experience applying these to transform care for CVD co-morbidities in South Africa and India. We have determined the barriers to CVD care and reviewed the literature to select a package of interventions proven successful in randomized controlled trials, including: use of non-clinician care coordinators to support treatment documentation and quality improvement (QI); incorporation of home monitoring to enhance self- management; decision-support tools to facilitate treatment initiation and modifications; and monthly audit / feedback meetings to support continuous QI. We will use the EPIS framework and partner with government, academic, facility, and community stakeholders to guide the project by: Exploring (engaging stakeholders in human-centered design to co-adapt the intervention package to align with local capacity, opportunities, and motivations, Aim UG1); Preparing (strengthening capacity in implementation science, Aim UG2); Implementing and evaluating the intervention package via a stepped wedge cluster trial and assessing both implementation (e.g., reach, adoption, fidelity) and effectiveness (e.g., controlled blood pressure [primary outcome] among PLWH and HTN), Aim UH1; measuring Sustainability and costs after 24 months (where 12 months were spent transferring delivery from study to local staff (Aim UH2); and developing a strategy to scale up to rural clinics and nationally (Aim UH3). The overall goal of this project is to employ rigorous empirical methods to develop and test care innovations that expand the scope of HIV care in a sustainable, scalable, and impactful way. We will employ an achievable milestone plan to deliver high quality outputs, including: continued stakeholder relationships and co-ownership of the study over the project period; completion of three PhDs in implementation science; and disseminating findings via high-impact publications and presentations. We will also participate in NHLBI’s collaborative multi-institution network designed to strengthen research methods and impacts across all sites, and to advance training of the next generation of scientific leaders.