Scaling Out and Scaling Up the Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis andCare Cascade for HIV-infected Individuals (SCALE SAIA HTN)

未经诊断和治疗的高血压（HTN）是心血管疾病的主要驱动因素， 占全球死亡人数的三分之一，不成比例地影响到低收入和中等收入国家。在整个南非，国家- 基于证据的指南在筛查和管理HTN方面的应用水平较低，并且由于缺乏 服务准备程度、卫生工作者动机不均衡、卫生工作者问责制度薄弱以及 HTN筛查和管理与慢性病护理服务相结合。在莫桑比克， 艾滋病毒感染率> 13%，艾滋病毒治疗平台是唯一规模化的慢性病护理服务。超过90万人 它提供了一个机会，标准化和规模HTN护理级联 服务低成本、系统一级的战略在改善连锁级联服务方面是有效的， 在现有的艾滋病毒服务中有效地实现HTN诊断和管理; HTN级联;以及改善患者水平的结果。 我们的提案建立在正在进行的SAIA-HTN试验的基础上。我们的UG 3/UH 3（SCALE SAIA- HTN）是建立一个强大的证据基础上的有效性，一个多组件的实施战略 （SAIA）使用“向外扩展”框架， 之前的有效性试验。SCALE SAIA-HTN将通过按地区提供的新模式进行“扩展” 卫生监督员（而不是研究护士）。我们还将通过扩大到所有地区来“扩大”SAIA-HTN， 新增两个省（15个区），作为全国推广的基础。我们提出三个目标， UG 3（规划）和UH 3（实施）阶段的两个。UG 3-目标1：制定多部门 建立关键利益攸关方的伙伴关系，并在国家一级建立HTN技术工作组， 参与省份UG 3-目标2：确定可能影响采用的关键促进因素和障碍， 整合、扩大和维持SAIA-HTN执行战略。UG 3-目标3：开展 试点研究，以评估地区监督员领导的SAIA-HTN干预的可行性和可接受性， 在一个初级保健设施进行为期数月的培训，并根据需要重新设计工具和标准作业程序， UH 3期。UH 3-目标1：为SCALE SAIA制定以地区为基础的传播和实施战略- HTN使用RE-AIM模型来评估计划的覆盖范围、有效性、采用率、实施情况和 上维护UH 3-目标2：确定SCALE SAIA-HTN用于护理级联优化的成本。我们将 估计将HTN诊断和管理纳入艾滋病毒护理的总增量和单位成本。

Undiagnosed and untreated hypertension (HTN) is a main driver of cardiovascular disease, contributing to a third of deaths globally, disproportionately affecting low and middle-income countries. Across sSA, country- level application of evidence-based guidelines to screen and manage HTN is low and variable due to lack of service readiness, uneven health worker motivation, weak health worker accountability systems, and poor integration of HTN screening and management with chronic care services. In Mozambique, where HIV prevalence is >13%, the HIV treatment platform is the only scaled chronic care service. With over 900,000 patients on anti-retroviral therapy, it presents an opportunity to standardize and scale HTN care cascade services. Low-cost, systems-level strategies are effective in improving linked cascade services and may be effective for routinizing HTN diagnosis and management within existing HIV services; improving flow through the HTN cascade; and improving patient-level outcomes. Our proposal builds on the ongoing SAIA-HTN trial. The overall objective of our UG3/UH3 (SCALE SAIA- HTN) is to establish a robust evidence base on the effectiveness of a multi-component implementation strategy (SAIA) on the HTN/HIV cascade using a ‘scaling-out’ framework, whereby strength can be ‘borrowed’ from prior effectiveness trials. SCALE SAIA-HTN will be ‘scaled out’ through a novel modality delivered by district health supervisors (rather than study nurses). We will also ‘scale up’ SAIA-HTN by expanding to all districts in two additional provinces (15 districts), serving as a foundation for national scale-up. We propose three aims for the UG3 (Planning) and two for UH3 (Implementation) phases. UG3-Aim 1: To develop a multi-sectoral partnership of key stakeholders and establish HTN technical working groups at the national level and with participating provinces. UG3-Aim 2: To identify key facilitators and barriers that could affect the adoption, integration, scale-up and sustainment of the SAIA-HTN implementation strategy. UG3-Aim 3: To conduct a pilot study to assess feasibility and acceptability of the district supervisor-led SAIA-HTN intervention over six months in one primary care facility and redesign tools and standard operating procedures as necessary for the UH3 phase. UH3-Aim 1: Develop a district-based dissemination and implementation strategy for SCALE SAIA- HTN using the RE-AIM model to evaluate the programs’ Reach, Effectiveness, Adoption, Implementation and Maintenance. UH3-Aim 2: Determine the costs of SCALE SAIA-HTN for care cascade optimization. We will estimate total incremental and unit costs of integrating HTN diagnosis and management into HIV care.