Integration of Hypertension Management into HIV Care in Nigeria: A Task Strengthening Strategy

尼日利亚将高血压管理纳入艾滋病毒护理：任务强化策略

• 批准号: 9926582
• 负责人: OLIVER CHUKWUJEKWU EZECHI
• 金额: $ 66.37万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-15 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9926582
• 关键词: Acquired Immunodeficiency Syndrome; Acute; Address; Adopted; Adoption; Africa; Caring; Characteristics; Chronic Care; Climate; Clinic; Clinical effectiveness; Collaborations; Counseling; Country; Data; Effectiveness; Evidence based intervention; Feedback; General Population; Ghana; HIV; Health; Health Insurance; Healthcare; Healthcare Systems; Hybrids; Hypertension; Income; Infrastructure; Institutes; Insurance Coverage; Intervention; Knowledge; Leadership; Life Style; Maintenance; Mediator of activation protein; Medical Research; Modeling; Morbidity - disease rate; New York; Nigeria; Nigerian; Nurses; Patients; Performance; Pharmaceutical Preparations; Phase; Physicians; Prevalence; Primary Health Care; Process; Protocols documentation; Qualitative Methods; Randomized; Reporting; Research; Risk; Risk Assessment; Role; Saints; Self-Direction; System; Testing; Titrations; Training; Translating; Universities; antiretroviral therapy; base; blood pressure reduction; burden of illness; clinical implementation; design; evidence base; experience; hypertension control; implementation research; implementation science; implementation strategy; knowledge base; low and middle-income countries; mortality; personalized approach; prevent; primary outcome; research to practice; routine care; routine practice; secondary outcome; system-level barriers; uptake

Project Abstract Access to highly active antiretroviral treatment led to increased survival of people living with HIV (PLWH) in Africa, which in turn increased their CVD burden. PLWH now experience high CVD-mortality probably due to uncontrolled hypertension (HTN). Based on Global Burden of Disease data, Nigeria had 95% increased HTN- related mortality from 1990 to 2015. Such high mortality could reverse the gains in survival among PLWH. In order to prevent such reversal, strategies to control HTN in PLWH are sorely needed. However acute shortage of healthcare workforce limits effective reduction of HTN-related morbidity. Task shifting of duties from physicians to nurses may mitigate this systems-level barrier to HTN control. In a cluster RCT of 32 health centers in Ghana, we showed that a nurse-led task-shifting strategy for HTN control (TASSH), based on the WHO CVD Risk Package, led to a 34% greater reduction in systolic BP than health insurance coverage (U01HL114198; PI: Ogedegbe). TASSH includes CV risk assessment; medication titration; and patient lifestyle counseling. Effective strategies for implementing evidence-based interventions (EBIs) like TASSH are typically multi-level. However, HIV clinics in Nigeria lack the expertise needed to coordinate practice changes without assistance. An implementation strategy to overcome this barrier is practice facilitation (PF) via provision of external expertise on practice redesign, and a tailored approach to provision of evidence-based care. PF provides expertise through an external coach, who provides support for implementing the EBI. Although PF has been widely utilized in high income countries, it role in translating EBIs into routine practice in Africa has not been tested. Thus, we will evaluate the effect of PF on implementing TASSH in HIV clinics. The Lagos State Primary Healthcare Board and its network of 67 HIV clinics provide a viable HIV chronic care platform for implementing TASSH as an integrated model for HTN control in PLWH. Using a hybrid clinical-effectiveness implementation design, we will conduct this study in 3 phases: 1) A pre-implementation phase using the Consolidated Framework for Implementation Research to tailor PF intervention for integrating TASSH into HIV clinics; 2) An implementation phase using RE- AIM to compare in a cluster RCT of 30 HIV clinics, the effect of PF vs. a self-directed condition (i.e. receipt of information on TASSH without PF) on BP reduction among 960 PLWH patients with HTN; and 3) A post- implementation phase to evaluate the effect of PF vs. self-directed condition on adoption and sustainability of TASSH. The PF intervention comprises: (a) an advisory board that will provide leadership support for TASSH implementation; and (b) trained nurses (practice facilitators) who will serve as coaches, provide support, knowledge exchange and performance feedback to the nurses who will deliver TASSH at the HIV clinics. Primary outcome is change in systolic BP from baseline to 12 months. Secondary outcomes are adoption [proportion of patients that adopted TASSH]; sustainability [maintenance of TASSH adoption at 24 mos]; and mediators of adoption and sustainability at 12 and 24 mos.

项目摘要 获得高效抗逆转录病毒治疗导致艾滋病毒携带者(PLWH)存活率增加 非洲，这反过来又增加了他们的心血管疾病负担。PLWH现在经历了高心血管疾病死亡率，可能是由于 失控高血压(HTN)。根据全球疾病负担数据，尼日利亚HTN增加了95%- 1990年至2015年的相关死亡人数。如此高的死亡率可能会逆转PLWH患者存活率的增长。在……里面 为了防止这种逆转，迫切需要控制PLWH中HTN的策略。然而，严重短缺 卫生保健劳动力的缺乏限制了HTN相关发病率的有效降低。医生职责转移的任务 对于护士来说，这可能会减轻控制HTN的系统水平的障碍。在加纳32个卫生中心的RCT集群中， 我们表明，基于WHO心血管疾病风险，护士主导的HTN控制任务转移策略(TASSH) 一揽子计划，导致收缩压比医疗保险覆盖范围内的收缩压下降34%(U01HL114198；PI： 奥格德贝)。TASSH包括CV风险评估、药物滴定和患者生活方式咨询。有效 实施像TASSH这样的循证干预(EBI)的战略通常是多层次的。然而， 尼日利亚的艾滋病毒诊所缺乏在没有援助的情况下协调实践变化所需的专业知识。一个 克服这一障碍的实施战略是通过提供外部专业知识促进实践(PF) 关于实践重新设计，以及提供循证护理的量身定做的方法。PF通过以下方式提供专业知识 外部指导，为实施EBI提供支持。尽管PF已被广泛应用于高技术领域 在收入国家，信息技术在将债务凭证转化为非洲常规做法方面的作用尚未得到检验。因此，我们将 评价PF在HIV临床实施TASSH中的效果。拉各斯州初级医疗保健委员会和 其由67家艾滋病毒诊所组成的网络为实施TASSH作为一个综合的艾滋病毒慢性护理平台提供了可行的艾滋病毒慢性护理平台 PLWH中HTN控制的模型。使用混合临床有效性实施设计，我们将进行 这项研究分三个阶段进行：1)使用执行综合框架的实施前阶段 研究为将TASSH整合到HIV临床而量身定做的PF干预；2)使用RE- 目的在30个HIV诊所的随机对照试验中，比较PF和自我指导条件(即接受 960例合并HTN的PLWH患者的TASSH(无PF)降压情况；3)术后 实施阶段，评估PF与自我指导条件对采用和可持续性的影响 塔什。爱国阵线的干预措施包括：(A)一个咨询委员会，将向塔斯社提供领导支助 实施；和(B)训练有素的护士(实习促进者)，他们将担任教练，提供支持， 向将在HIV诊所实施TASSH的护士进行知识交流和绩效反馈。主要 结果是从基线到12个月的收缩压变化。次要结果是采用[比例 采用TASSH的患者]；可持续性[将TASSH采用维持在24个月]；以及 12个月和24个月的采用率和可持续性。