Integrating HIV and hEART health in South Africa (iHeart-SA)

在南非整合艾滋病毒和心脏抗逆转录病毒治疗 (iHeart-SA)

• 批准号: 10267701
• 负责人: Mohammed Kumail Ali
• 金额: $ 85.9万
• 依托单位: WITS HEALTH CONSORTIUM (PTY), LTD
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-25 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10267701
• 关键词: Address; Administrator; Adopted; Adoption; Adult; African; Award; Awareness; Blood Glucose Self-Monitoring; Blood Pressure; Cardiac health; Cardiovascular Diseases; Caring; Clinic; Clinical; Collaborations; Communities; Country; Detection; Diabetes Mellitus; Diagnosis; Doctor of Philosophy; Documentation; Effectiveness; Ethics; Event; Evidence based intervention; Feedback; Glucose; Goals; Government; Guidelines; HIV; HIV Seronegativity; Health care facility; Home; Human; Human Resources; Hypertension; India; Institution; International; Intervention; Knowledge; Maintenance; Measurement; Measures; Mentorship; Meta-Analysis; Methods; Modeling; Modification; Monitor; Morbidity - disease rate; Motivation; National Heart, Lung, and Blood Institute; Output; Ownership; Patients; Phase; Preparation; Protocols documentation; Provider; Public Sector; Publications; Randomized Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Research; Research Methodology; Research Personnel; Resources; Review Literature; Risk; Risk Assessment; Risk Factors; Risk Reduction; Rural; Scientist; Self Management; Site; South Africa; Stroke; Structure; System; Testing; Training; Work; antiretroviral therapy; behavior change; budget impact; burden of illness; cardiovascular disorder risk; care delivery; cluster trial; comorbidity; cost; cost estimate; design; effectiveness evaluation; experience; glucose monitor; heart disease risk; hybrid type 2 design; hypertension control; hypertension treatment; implementation research; implementation science; implementation strategy; improved; innovation; intervention cost; meetings; mortality; multidisciplinary; next generation; pandemic disease; patient-level barriers; primary outcome; programs; provider-level barriers; response; scale up; screening; success; support tools; system-level barriers; tool; treatment strategy

ABSTRACT Our multidisciplinary, multi-country team of implementation science experts propose to adapt, implement, and evaluate the “Integrating HIV and hEART health in South Africa” (iHeart-SA) program that incorporates hypertension (HTN) and diabetes (DM) screening and treatment for people living with HIV (PLWH). SA is the epicenter of the HIV pandemic worldwide with over 7 million PLWH, of whom ~5 million are treated with anti- retroviral therapies (ART). ART rollout has two relevant repercussions: first, PLWH now have approximately twice the risk of developing HTN, DM, and cardiovascular disease (CVD); and second, the success of ART programs creates a corresponding mandate to deliver integrated, high-quality, sustainable treatment strategies to detect, treat, and control HTN and DM in HIV care. There are patient-, provider-, and system-level barriers to achieving these goals; but, there are also evidence-based interventions to address them, and we have extensive experience applying these to transform care for CVD co-morbidities in South Africa and India. We have determined the barriers to CVD care and reviewed the literature to select a package of interventions proven successful in randomized controlled trials, including: use of non-clinician care coordinators to support treatment documentation and quality improvement (QI); incorporation of home monitoring to enhance self- management; decision-support tools to facilitate treatment initiation and modifications; and monthly audit / feedback meetings to support continuous QI. We will use the EPIS framework and partner with government, academic, facility, and community stakeholders to guide the project by: Exploring (engaging stakeholders in human-centered design to co-adapt the intervention package to align with local capacity, opportunities, and motivations, Aim UG1); Preparing (strengthening capacity in implementation science, Aim UG2); Implementing and evaluating the intervention package via a stepped wedge cluster trial and assessing both implementation (e.g., reach, adoption, fidelity) and effectiveness (e.g., controlled blood pressure [primary outcome] among PLWH and HTN), Aim UH1; measuring Sustainability and costs after 24 months (where 12 months were spent transferring delivery from study to local staff (Aim UH2); and developing a strategy to scale up to rural clinics and nationally (Aim UH3). The overall goal of this project is to employ rigorous empirical methods to develop and test care innovations that expand the scope of HIV care in a sustainable, scalable, and impactful way. We will employ an achievable milestone plan to deliver high quality outputs, including: continued stakeholder relationships and co-ownership of the study over the project period; completion of three PhDs in implementation science; and disseminating findings via high-impact publications and presentations. We will also participate in NHLBI’s collaborative multi-institution network designed to strengthen research methods and impacts across all sites, and to advance training of the next generation of scientific leaders.

摘要 我们的多学科、多国家实施科学专家团队建议调整、实施和 评估“在南非整合艾滋病毒和心脏健康”(iHeart-SA)计划 高血压(HTN)和糖尿病(DM)筛查和艾滋病毒携带者(PLWH)治疗。SA是最重要的 全球艾滋病毒大流行的震中，有700多万PLWH，其中约500万人接受抗- 逆转录病毒疗法(ART)。ART的推出有两个相关的影响：第一，PLWH现在大约有 患HTN、DM和心血管疾病(CVD)的风险增加一倍；第二，ART的成功 方案创造了相应的任务，以提供综合的、高质量的、可持续的治疗战略 在HIV护理中检测、治疗和控制HTN和DM。存在患者、提供者和系统级别的障碍 实现这些目标；但是，也有基于证据的干预措施来解决这些问题，我们已经 在南非和印度应用这些来改变对心血管疾病共病的护理具有丰富的经验。我们 已经确定了心血管疾病护理的障碍，并查阅了文献以选择一揽子干预措施 在随机对照试验中证明成功，包括：使用非临床医生护理协调员来支持 治疗记录和质量改进(QI)；纳入家庭监测，以增强自我 管理；促进治疗启动和修改的决策支持工具；每月审计/ 支持持续质量改进的反馈会议。我们将使用EPIS框架并与政府合作， 学术、设施和社区利益相关者通过以下方式指导项目：探索(让利益相关者参与 以人为本的设计，共同调整干预方案，以符合当地的能力、机会和 动机，目标UG1)；准备(加强执行科学能力，目标UG2)； 通过阶梯式楔形群组试验实施和评估干预方案，并对两者进行评估 实施(例如，覆盖、收养、保真度)和有效性(例如，控制血压[主要 结果]在PLWH和HTN中)，AIM UH1；24个月后衡量可持续性和成本(其中12 花了几个月的时间将教学从学习转移到当地工作人员(AIM UH2)；并制定了扩大规模的战略 乡村诊所和全国(目标UH3)。该项目的总体目标是采用严谨的实证 开发和测试护理创新的方法，以可持续、可扩展、 和有影响力的方式。我们将采用一个可实现的里程碑计划来提供高质量的产出，包括： 在项目期间继续与利益攸关方建立关系并共同拥有研究报告；完成三项 实施科学博士学位；以及通过影响较大的出版物和演示文稿传播研究成果。 我们还将参与NHLBI旨在加强研究的多机构合作网络 所有地点的方法和影响，并推进对下一代科学领袖的培训。