Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SAIA-HTN)

优化 HIV 感染者高血压诊断和护理级联的系统分析和改进方法 (SAIA-HTN)

• 批准号: 9924633
• 负责人: Sarah Odell Gimbel
• 金额: $ 67.09万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9924633
• 关键词: Accountability; Address; Adherence; Adoption; Adult; Affect; Africa South of the Sahara; Antihypertensive Agents; Area; Awareness; Blood Pressure; Blood Pressure Monitors; Cardiovascular Diseases; Caring; Cessation of life; Chronic Care; Clinical; Cluster randomized trial; Communication; Complex; Consensus; Cost Effectiveness Analysis; Cost Measures; Country; Data; Decision Making; Detection; Diagnosis; Effectiveness; Environment; Evidence based intervention; Facility Controls; Failure; Focus Groups; Foundations; Goals; Guidelines; HIV; Health; Health Personnel; Heterogeneity; Hypertension; Individual; Intervention; Interview; Laboratories; Link; Mainstreaming; Measures; Modeling; Modification; Mother-to-child HIV transmission; Motivation; Mozambique; Outcome; Output; Patient Care; Patient-Focused Outcomes; Patients; Performance; Pharmaceutical Preparations; Pharmacy facility; Policies; Population; Prevalence; Prevention; Process; Qualitative Evaluations; Readiness; Reporting; Resources; Services; Standardization; System; Systems Analysis; Testing; Viral; antiretroviral therapy; care systems; cost; cost effectiveness; cost utility analysis; design; disability-adjusted life years; effective intervention; evidence base; flexibility; hypertension control; implementation research; improved; informant; innovation; intervention cost; low and middle-income countries; low income country; novel; outpatient programs; population health; prospective; randomized controlled design; scale up; screening; service delivery; success; system-level barriers; systematic review; therapy design; tool

Undiagnosed and untreated hypertension (HTN) is one of the largest drivers of cardiovascular disease (CVD) in sub-Saharan Africa (sSA). Across sSA, evidence-based, clinical guidelines to screen and manage hypertension exist; however, country level application is low and uneven due to lack of service readiness, uneven health worker motivation, lack of accountability for health worker performance and poor integration of HTN screening and management with chronic care services. In Mozambique – like many countries with high HIV burden – the HIV treatment platform was the first broadly implemented chronic care service. With large numbers of patients on anti-retroviral treatment (850,000 in Mozambique), it presents a unique opportunity to standardize and scale hypertension screening and management. Low-cost, systems level interventions are effective and efficient approaches to improve linked cascade services, and may be effective for routinizing HTN diagnosis and management within existing chronic care services; addressing both individual and systems-level barriers; improving flow through the HTN cascade; and ultimately improving patient level outcomes. The Systems Analysis and Improvement Approach (SAIA) is designed to optimize cascade performance, is feasible for frontline healthcare workers and managers, and is applicable to optimize the HTN testing and treatment cascade for people living with HIV (PLHIV) across multiple contexts. We have successfully piloted SAIA for the HTN cascade for PLHIV, and as HTN screening and management is mainstreamed into chronic care services in sSA (including in Mozambique), demonstrating SAIA-HTN potential effectiveness as an adaptable, scalable model for broad implementation. The overall goal of SAIA-HTN is to evaluate a model for systematic assessment and improvement of HTN diagnosis and management services for PLHIV in Mozambique. Our specific aims are to: (1) Determine the effectiveness of SAIA-HTN on HTN cascade optimization for HIV-infected individuals; (2) Determine the drivers of SAIA-HTN intervention implementation heterogeneity across facilities; (3) Determine the costs and cost-effectiveness of SAIA-HTN for care cascade optimization. We will deploy a cluster randomized trial to evaluate the impact of the SAIA-HTN intervention on hypertension management in 8 intervention and 8 control facilities. Effectiveness will be measured via HTN cascade flow measures for PLHIV and HTN and HIV clinical outcomes. Intervention costs will be assessed from the payer perspective (e.g. MOH), and cost effectiveness analysis conducted to estimate the incremental costs for additional patients passing through the HTN cascade steps, and the cost per additional disability-adjusted life year averted (DALY). The implementation process will be described using focus group discussions and key informant interviews analyzed using the Consolidated Framework for Implementation Research, with complementary data from study logs to describe fidelity to the SAIA-HTN intervention design.

未经诊断和治疗的高血压（HTN）是心血管疾病的最大驱动因素之一 (CVD)在撒哈拉以南非洲（sSA）。在整个sSA中，循证临床指南用于筛查和管理 高血压是存在，但是，由于缺乏服务准备， 卫生工作者的积极性不均衡，缺乏对卫生工作者业绩的问责，以及融合不佳 HTN筛查和管理与慢性病护理服务。在莫桑比克-像许多国家一样， 艾滋病毒负担沉重-艾滋病毒治疗平台是第一个广泛实施的长期护理服务。与 由于大量患者接受抗逆转录病毒治疗（莫桑比克有85万人）， 有机会使高血压筛查和管理标准化和规模化。低成本，系统级 干预措施是改善连锁级联服务的有效和高效方法， 在现有的慢性病护理服务中有效地实现HTN诊断和管理; 解决个人和系统层面的障碍;改善通过高技术网络级联的流动;以及 最终改善患者水平的结果。 系统分析和改进方法（SAIA）旨在优化级联性能， 对于一线医护人员和管理者是可行的，适用于优化HTN检测， 艾滋病毒感染者（PLHIV）在多种情况下的治疗级联。我们已经成功地 艾滋病毒感染者高血压病级联的SAIA，以及高血压病筛查和管理被纳入慢性 在南非（包括莫桑比克）提供保健服务，证明SAIA-HTN作为 适应性强、可扩展的模型，可广泛实施。SAIA-HTN的总体目标是评估一个模型 系统评估和改善艾滋病毒感染者的HTN诊断和管理服务， 莫桑比克.我们的具体目标是：（1）确定SAIA-HTN对HTN级联的有效性 （2）确定SAIA-HTN干预实施的驱动因素 不同设施之间的异质性;（3）确定SAIA-HTN用于护理级联的成本和成本效益 优化.我们将开展一项随机分组试验，以评估SAIA-HTN干预的影响。 在8个干预机构和8个控制机构进行高血压管理。有效性将通过 用于PLHIV和HTN以及HIV临床结局的HTN级联流测量。干预成本将 从付款人的角度（如卫生部）进行评估，并进行成本效益分析， 通过HTN级联步骤的额外患者的增量成本，以及每个额外患者的成本 避免残疾调整生命年（DALY）实施过程将使用焦点小组进行描述 使用《实施综合框架》分析讨论和关键知情人访谈 研究，与研究日志的补充数据，以描述对SAIA-HTN干预设计的保真度。