Managing Hypertension Among People Living with HIV: an Integrated Model (MAP-IT)

HIV 感染者的高血压管理：综合模型 (MAP-IT)

• 批准号: 10267033
• 负责人: Angela Attah
• 金额: $ 63.78万
• 依托单位: UNIVERSITY OF ABUJA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-20 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10267033
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adoption; Advocate; Africa; Anti-Retroviral Agents; Cardiovascular Diseases; Caring; Chronic; Chronic Care; Collaborations; Communication; Counseling; Country; Data; Data Analyses; Data Collection; Decision Making; Development; Diabetes Mellitus; Disease Management; Evidence based intervention; Faculty; Family health status; Feedback; Funding; General Population; Ghana; Goals; Grant; HIV; Health; Health Insurance; Health Services; Health Services Accessibility; Healthcare Systems; Hypertension; Income; Infrastructure; Insurance Coverage; International; Intervention; Knowledge; Leadership; Life Style; Manuals; Methods; Modeling; Monitor; Needs Assessment; New York; Nigeria; Nurses; Patients; Performance; Pharmaceutical Preparations; Phase; Physicians; Prevalence; Primary Health Care; Procedures; Process; Protocols documentation; Public Health; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Risk; Risk Assessment; Role; Saints; Services; Site; Support System; System; Testing; Titrations; Training; Training Support; Translating; USAID; United States National Institutes of Health; Universities; base; blood pressure reduction; blood pressure regulation; burden of illness; cardiovascular disorder risk; comorbidity; cost effective; design; effectiveness evaluation; evidence base; experience; feasibility testing; hypertension control; implementation fidelity; implementation framework; implementation protocol; implementation science; implementation strategy; improved; knowledge base; low and middle-income countries; mortality; primary outcome; programs; recruit; research to practice; routine practice; secondary outcome; service programs

This proposal is a collaboration between University of Abuja, FHI 360, New York University and Saint Louis University. Access to antiretroviral drugs has led to increased survival of people living with HIV (PLWH), who now experience higher CVD-mortality than the general population, largely due to increased HTN burden. Global Burden of Disease reported a 95% increase in HTN-related mortality in Nigeria from 1990 to 2015. Thus, strategies to control HTN in PLWH are sorely needed. Physician shortage and poor access limit Nigeria’s capacity to control HTN in primary health centers (PHCs), where most PLWH receive care. Access to care and task-shifting of duties to nurses may mitigate these barriers. In 2011, FHI 360 initiated a USAID-funded program, Strengthening Integrated Delivery of HIV-AIDS Services (SIDHAS), which provides universal access to HIV services for over 190,000 PLWH in Nigeria . 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 systolic BP reduction than health insurance coverage alone (U01HL114198; PI: Ogedegbe). TASSH includes CV risk assessment; medication titration; and patient lifestyle counseling. The existence of an effective HIV chronic are platform (SIDHAS) and a well-proven evidence-based intervention for HTN control (TASSH) provides a unique opportunity for implementation of TASSH as an integrated NCD-HIV model for HTN control in PLWH. However, PHCs in Nigeria [with its weak healthcare system] lack the expertise needed to coordinate multilevel system changes. An implementation strategy to overcome this barrier is PF via provision of external expertise and support for addressing challenges in implementing evidence-based care. Although PF has been widely utilized in high income countries, its role in translating EBIs into routine practice in Africa has not been tested. FHI 360’s SIDHAS program and the 47 PHCs it supports in Akwa Ibom – [the state with the highest HIV burden in Nigeria] - provide a viable HIV chronic care platform for implementing TASSH as an integrated model for HTN control in PLWH. We will conduct this study in two phases using a mixed-methods design: 1) a UG3 planning phase that will use Promoting Action on Research in Health Services (PARiHS) to develop a context- specific PF strategy to implement, and facilitate integration of TASSH into an HIV chronic care platform (SIDHAS) for management of HTN in PLWH; and 2) a UH3 implementation phase that will use Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) to evaluate, in a stepped-wedge cluster RCT of 30 PHCs in 960 PLWH with uncontrolled HTN, the effect of PF on levels of TASSH adoption (primary outcome); BP control (co-primary outcome); and levels of TASSH sustainment (secondary outcome) at 18 months. We will also examine adoption and implementation fidelity of TASSH as potential mechanisms that may explain the impact of PF on BP control. The PF strategy 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 PHCs.

这项建议是阿布贾大学、FHI 360、纽约大学和圣刘易斯大学之间的合作 大学获得抗逆转录病毒药物提高了艾滋病毒感染者（PLWH）的生存率， 现在经历比一般人群更高的CVD死亡率，主要是由于HTN负担增加。全球 疾病负担报告称，从1990年到2015年，尼日利亚的HTN相关死亡率增加了95%。因此，在本发明中， 迫切需要控制艾滋病毒携带者中高血压的策略。医生短缺和穷人访问限制尼日利亚的 在大多数艾滋病毒携带者和艾滋病患者接受治疗的初级保健中心，控制艾滋病毒携带者和艾滋病患者的能力。获得护理和 将职责转移给护士可能会减轻这些障碍。2011年，FHI 360发起了一个由美国国际开发署资助的项目， 加强艾滋病毒/艾滋病综合服务的提供，使艾滋病毒的防治工作得到普及 为尼日利亚的190 000多名艾滋病毒携带者提供服务。在加纳32个健康中心的随机对照试验中，我们发现， 根据WHO CVD风险包，护士主导的HTN控制任务转移策略（TASSH）导致34%的 收缩压下降幅度大于单独的健康保险（U 01 HL 114198; PI：Ogedegbe）。TASSH 包括CV风险评估、药物滴定和患者生活方式咨询。存在有效 艾滋病毒慢性病平台（SIDHAS）和一个经过充分验证的HTN控制循证干预措施（TASSH） 提供了一个独特的机会，实施TASSH作为一个综合的非传染性疾病-艾滋病毒模型，用于HTN控制， PLWH。然而，尼日利亚的初级保健中心（其医疗保健系统薄弱）缺乏协调所需的专业知识 多层次的系统变化。克服这一障碍的一个实施战略是通过提供外部 提供专业知识和支持，以应对实施循证护理方面的挑战。虽然PF 在高收入国家广泛使用，它在非洲将EBI转化为常规做法的作用尚未得到充分发挥。 测试. FHI 360的SIDHAS计划及其在阿夸伊博姆（艾滋病毒感染率最高的州）支持的47个初级保健中心 负担在尼日利亚] -提供一个可行的艾滋病毒慢性护理平台，以执行TASSH作为一个综合模式 用于PLWH中的HTN控制。我们将使用混合方法设计分两个阶段进行这项研究：1）UG 3 规划阶段，将利用促进卫生服务研究行动（PARiHS）来制定一个背景- 实施并促进将艾滋病毒/艾滋病防治战略纳入艾滋病毒慢性病护理平台的具体方案基金战略 用于管理PLWH中的HTN;以及2）UH 3实施阶段，将使用范围，有效性， 采用、实施和维护（RE-AIM），在30个PHC的阶梯楔形簇RCT中进行评价 在960例未控制HTN的PLWH中，PF对TASSH采用水平的影响（主要结局）; BP控制 （共同主要结局）;以及18个月时TASSH维持水平（次要结局）。我们还将 检查TASSH的采用和实施保真度，作为可能解释影响的潜在机制 PF对BP的控制作用。方案基金战略包括：（a）一个咨询委员会，将为以下方面提供领导支助： TASSH的实施;以及（B）经过培训的护士（实践促进者），他们将担任教练，提供支持， 向在初级保健中心提供TASSH的护士提供知识交流和绩效反馈。