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: 9345176
• 负责人: Monika Roy
• 金额: $ 19.88万
• 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 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9345176
• 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; Testing; Time; Training; Transportation; Zambia; analytical method; antiretroviral therapy; base; blood pressure reduction; blood pressure regulation; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular risk factor; care delivery; career; career development; community based treatment; cost; design; experience; hypertension control; hypertension treatment; implementation research; implementation science; improved; innovation; member; modifiable risk; novel strategies; opportunity cost; 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 据估计，撒哈拉以南非洲地区 2180 万艾滋病毒感染者中，有 10-30% 患有高血压， 心血管疾病（CVD）的单一最大危险因素。高血压未经治疗的后果是 HIV 感染者发生 CVD 事件的风险比 HIV 感染者高 50% 即使在控制了传统的 CVD 风险因素后，未感染者的情况也是如此。尽管艾滋病病毒感染规模不断扩大 治疗意味着数以百万计的患者现在需要与卫生系统联系，但对治疗的了解却很差 这些人群中的高血压治疗仍在继续。因此，只有不到 10% 的高血压患者 接受艾滋病毒治疗的患者血压得到控制。因为艾滋病毒和高血压管理有共同之处 许多障碍（例如，获得护理的机会成本），艾滋病毒治疗的新兴解决方案也代表 改善非洲其他慢性病治疗的可及性和可持续性的关键机会。 拟议的 K23 研究旨在了解增加高血压的可实施性和效果 赞比亚艾滋病毒治疗纳入“社区依从小组”（CAG）模式。在目标 1 中，我们将 通过测量采用率、保真度来评估高血压护理在该模型中的实施情况 随着时间的推移，高血压药物的实施和可持续性。在目标 2 中，我们将使用 前后设计来评估引入的血压实践的有效性。在目标 3 中，我们 将通过对医护人员和患者进行深入访谈和焦点小组来了解如何 优化模型的可接受性、适合性和影响力，以便将来传播并最终扩展到 患有高血压的未感染艾滋病毒的人群。我目前正忙于一项由该法案支持的项目 梅琳达·盖茨基金会致力于在赞比亚实施和扩大 CAG 艾滋病毒治疗模式。 我对 CAG 实施的实践知识将使高血压成分添加到 CAG模型立即可行。所提出的科学目标的结果将告知 R01 评估 传播 HIV 和高血压综合治疗 CAG 模型和 R21，将该模型扩展到 未感染艾滋病毒的患者。 这个拟议的指导职业发展奖的总体目标是支持我的发展 独立实施科学研究人员，专注于慢性病卫生系统创新 资源有限环境中的疾病。 K23 的职业发展目标是获得 (1) 方面的专业知识 实施科学理论在研究设计和评估中的应用； (2) 分析方法 相关数据和纵向数据； (3) 在实施研究中使用定性方法以及 (4) 定位研究问题和发现，以优化对实践和政策的影响。该计划将 在具有艾滋病毒和艾滋病专业知识的国际导师团队的课程和指导下进行 心血管疾病流行病学、实施科学、生物统计学和混合方法研究。