Supplement: Implementation Research Strategies for Heart, Lung, and Blood Co-morbidities in People Living with HIV - Research Coordinating Center

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Project Summary Low- and middle-income countries (LMICs) are facing an escalating burden of heart, lung, blood, and sleep (HLBS) disorders among people with HIV (PWH). In implementing interventions to ameliorate this burden, evaluation of cost, cost-effectiveness, and budget impact are increasingly important. Furthermore, implementing integrated care in LMICs involves unique economic considerations. For example, launching such interventions often involves major up-front costs (e.g., reorganizing systems of care, investing in technological or other infrastructure), whereas health benefits are more uncertain and only accrue over time. Similarly, it is difficult to compare the costs of integrated care against an “unintegrated” standard of care in which non- communicable diseases (NCDs) such as hypertension are often not diagnosed or treated at all. The HLB- SIMPLe Alliance is a highly collaborative consortium that is evaluating the implementation of diverse and culturally relevant interventions for hypertension control among PWH in six sub-Saharan African countries (South Africa, Botswana, Zambia, Mozambique, Uganda, and Nigeria). Led by a designated Cost- Effectiveness Subgroup, the HLB-SIMPLe Alliance is taking a coordinated approach to evaluating the cost and cost-effectiveness of these interventions. Currently, funding exists through the individual grants of the HLB- SIMPLe Alliance to develop a set of standardized instruments and to collect data on costs in four of the six participating sites. This Supplement will build on these activities through three Specific Aims to optimize the scientific impact of NHLBI’s investment in the HLB-SIMPLe Alliance infrastructure in the field of economic evaluation. In Aim 1, we will expand our coordinated cost data collection efforts to the two remaining sites, thereby enhancing the generalizability and relevance of our findings. In Aim 2, we will create an accessible toolkit for use by other researchers and investigators seeking to evaluate the costs and cost-effectiveness of integrated HIV/NCD care. We will also use the HLB-SIMPLe studies to “pressure-test” and refine this toolkit, making our findings openly available to both scientific and implementation communities. In this way, we will ensure that lessons learned through the HLB-SIMPLe experience inform a broader array of decision-makers and advance scientific understanding of the economics of implementing integrated HIV/NCD care. In Aim 3, we will develop a year-long capacity building program, culminating in a ten-day summit in one of our African sites, to ensure that our African collaborators use the experience of the HLB-SIMPLe Alliance as a springboard to become leaders in this emerging research niche. Successful completion of the Aims in this Administrative Supplement will therefore enable us to take full advantage of the infrastructure of the HLB-SIMPLe Alliance to improve economic evaluation of integrated HIV/NCD care – both within the Alliance and (led by our African partners) throughout the scientific community as a whole.