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)

扩展和扩展系统分析和改进方法，以优化 HIV 感染者的高血压诊断和护理级联 (SCALE SAIA HTN)

• 批准号: 10255521
• 负责人: Ana Olga Mocumbi
• 金额: $ 77.44万
• 依托单位: EDUARDO MONDLANE UNIVERSITY
• 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 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10255521
• 关键词: Accountability; Address; Adherence; Adopted; Adoption; Adult; Affect; Africa South of the Sahara; Antihypertensive Agents; Area; Awareness; Biological Models; Blood Pressure; Cardiovascular Diseases; Caring; Cessation of life; Chronic Care; Cities; Clinical; Cluster randomized trial; Communities; Complex; Consolidated Framework for Implementation Research; Country; Diagnosis; Dissemination and Implementation; Effectiveness; Effectiveness of Interventions; Elements; Engineering; Failure; Foundations; Goals; HIV; Health; Health Status; Health care facility; Hypertension; Individual; Intervention; Link; Maintenance; Modality; Modeling; Modification; Motivation; Mozambique; Nurses; Nursing Research; Outcome; Output; Patient-Focused Outcomes; Patients; Performance; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Prevalence; Primary Health Care; Procedures; Process Measure; Province; Public Health; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Reporting; Research; Research Support; Services; Standardization; Subgroup; System; Systems Analysis; Testing; Time; Treatment Effectiveness; Viral Load result; acceptability and feasibility; antiretroviral therapy; base; care systems; cost; design; dissemination strategy; effective intervention; effectiveness trial; evidence base; evidence based guidelines; flexibility; hypertension control; hypertension treatment; implementation process; implementation strategy; improved; intervention effect; low and middle-income countries; novel; organizational readiness; population health; programs; scale up; screening; success; system-level barriers; systematic review; tool; uptake; working group

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.

未经诊断和未经治疗的高血压（HTN）是心血管疾病的主要驱动因素，导致 占全球死亡人数的三分之一，对低收入和中等收入国家的影响尤为严重。整个南澳州，国家- 由于缺乏证据，用于筛查和管理高血压的循证指南的应用水平较低且变化多端。 服务准备情况、卫生工作者积极性参差不齐、卫生工作者问责制度薄弱以及贫困 将高血压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 患病率>13%，艾滋病毒治疗平台是唯一规模化的慢性病护理服务。拥有超过 900,000 接受抗逆转录病毒治疗的患者，它提供了标准化和扩展 HTN 护理级联的机会 服务。低成本、系统级策略可有效改善关联级联服务，并且可能 有效地在现有的艾滋病毒服务范围内实现艾滋病毒诊断和管理的常规化；改善流通 HTN级联；并改善患者的治疗效果。 我们的提案以正在进行的 SAIA-HTN 试验为基础。我们的 UG3/UH3 (SCALE SAIA- HTN）旨在建立一个关于多组件实施策略有效性的强大证据基础 (SAIA) 使用“横向扩展”框架来研究 HTN/HIV 级联，从而可以“借用”力量 之前的有效性试验。规模 SAIA-HTN 将通过地区提供的新颖模式进行“扩展” 健康监督员（而不是研究护士）。我们还将通过扩展到所有地区来“扩大”SAIA-HTN 另外两个省（15 个区），作为全国推广的基础。我们提出三个目标 UG3（规划）阶段和两个 UH3（实施）阶段。 UG3-目标 1：发展多部门 主要利益攸关方建立伙伴关系，并在国家层面建立 HTN 技术工作组并与 参与省份。 UG3-目标 2：确定可能影响采用的关键促进因素和障碍， SAIA-HTN 实施战略的整合、扩大和维持。 UG3-目标 3：进行 试点研究评估地区主管领导的 SAIA-HTN 干预措施的可行性和可接受性超过六个 在一个初级保健机构中呆上几个月，并根据需要重新设计工具和标准操作程序 UH3相。 UH3-目标 1：为 SCALE SAIA 制定以地区为基础的传播和实施策略 HTN 使用 RE-AIM 模型来评估计划的范围、有效性、采用、实施和 维护。 UH3-目标 2：确定 SCALE SAIA-HTN 护理级联优化的成本。我们将 估计将 HTN 诊断和管理纳入 HIV 护理的总增量和单位成本。