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: 10838705
• 负责人: Chris Todd Longenecker
• 金额: $ 50.52万
• 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 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10838705
• 关键词: Address; Adherence; Adoption; Africa South of the Sahara; Antihypertensive Agents; Biometry; Blood Pressure; Blood Pressure Monitors; Cardiovascular Diseases; Caring; Cessation of life; Chronic; Client; Climate; Clinic; Clinical; Cluster randomized trial; Collaborations; Complex; Computer software; Cost Effectiveness Analysis; Data; Diagnosis; Diagnostic Equipment; Economics; Ensure; Equipment; Equity; Expenditure; Future; Goals; Government; HIV; HIV Infections; Health; Health system; Household; Hybrids; Hypertension; Intervention; Knowledge; Learning; Measurement; Methodology; Methods; Modeling; Modification; Monitor; Nigeria; Outcome; Participant; Patients; Performance; Persons; Pharmaceutical Preparations; Postdoctoral Fellow; Provider; Randomized; Reporting; Research Design; Research Personnel; Resources; Risk; Risk Reduction; Running; Sample Size; Service delivery model; Site; Social Network; Software Design; Specific qualifier value; Statistical Methods; System; Training; Uganda; Update; Visit; Work; Zambia; antiretroviral therapy; blood pressure medication; cardiovascular risk factor; comorbidity; compare effectiveness; cost; cost effective; cost effectiveness; design; disability; doctoral student; effectiveness evaluation; effectiveness outcome; evidence base; formative assessment; human centered design; hybrid type 2 design; hypertension control; hypertensive; implementation outcomes; implementation strategy; implementation trial; improved; incremental cost; innovation; integrated care; learning strategy; method development; peer; peri-urban; preservation; prevent; primary outcome; process evaluation; remote patient monitoring; routine practice; service delivery; statistics; theories; uptake; user friendly software

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.

项目概要 慢性艾滋病毒感染是心血管疾病的一个公认的危险因素。在撒哈拉以南非洲）—a 该地区可能占全球因艾滋病毒导致的心血管疾病负担的一半——高血压是最严重的 CVD 风险的重要驱动因素。有效的高血压管理存在深刻的障碍，包括有限的 知识、血压测量不一致以及难以获得药物。艾滋病毒护理创新，例如 获得免费抗逆转录病毒治疗、提供差异化​​服务以及在护理模式中使用艾滋病毒感染者同伴 可以改善高血压等合并症的护理。 PULESA-乌干达的总体目标 研究旨在改善城市和城郊艾滋病毒感染者 (PLHIV) 的血压治疗级联 乌干达以可扩展和可持续的方式。这项混合 IS 3 型研究建议首先探索 HIV 临床环境中循证血压护理的当前实践、常规、障碍和促进因素 坎帕拉和瓦基索地区（目标 1）。然后，采用以人为本的设计方法，设计团队 主要利益相关者将使用形成性评估的数据来制定多组成部分 实施策略 (HTN-PLUS)，以提高对循证 BP 的采用和遵守 根据乌干达艾滋病毒诊所的具体情况进行治疗（分目标 1.1）。设计团队将进行调整 差异化的服务提供模式、高血压艾滋病病毒感染者同伴支持者的使用以及血压控制方法 监测可解决血压护理的特定障碍和促进因素。在阶梯式楔形簇中随机 对坎帕拉和瓦基索的 16 个诊所进行试验，我们将确定实施的有效性 改善 BP 级联指标的策略（目标 2）。诊所将随机接受免费和 持续获得诊断设备和循证抗高血压药物 (HTN-BASIC) 没有子目标 1 (HTN-PLUS) 中制定的多组件实施策略。初级 有效性结果将是高血压诊断得到控制的患者百分比（<140mmHg 收缩期）。我们假设 HTN-BASIC 干预会将控制率从基线时的 25% 提高到 35%， HTN-PLUS 将进一步将控制率提高至 40%。我们将进行广泛的混合方法流程 评估。我们将评估可扩展性作为我们的主要实施成果，还将评估可接受性， 采用和实施氛围。最后，我们将评估经济和金融的可持续性 从社会角度进行成本效益分析的综合护理策略，其中包括 家庭自付费用。该目标的主要成果将是每个 BP 的增量成本 受控制的病人。这项研究将为 SSA 政府利益相关者提供急需的证据 通过预防心血管疾病导致的死亡和残疾来保持艾滋病毒治疗的健康收益的战略。 重要的是，它将提供艾滋病病毒模型的可扩展性、可持续性和公平性的经济证据。 高血压管理一体化。