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.

抽象的 我们的多学科、多国家实施科学专家团队建议适应、实施和 评估“在南非整合艾滋病毒和心脏ART健康”（iHeart-SA）计划，该计划纳入了 对艾滋病毒感染者 (PLWH) 进行高血压 (HTN) 和糖尿病 (DM) 筛查和治疗。 SA 是 全球艾滋病毒大流行的中心，有超过 700 万感染者，其中约 500 万人正在接受抗艾滋病治疗 逆转录病毒疗法（ART）。 ART 的推出有两个相关影响：首先，感染者现在大约有 患高血压、糖尿病和心血管疾病 (CVD) 的风险增加一倍；其次，ART 的成功 计划制定了相应的任务，以提供综合、高质量、可持续的治疗策略 在艾滋病毒护理中检测、治疗和控制高血压和糖尿病。存在患者、提供者和系统层面的障碍 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，应用这些方法来改变对 CVD 合并症的护理具有丰富的经验。我们 确定了 CVD 护理的障碍并查阅文献以选择一揽子干预措施 在随机对照试验中被证明是成功的，包括： 使用非临床护理协调员来支持 治疗记录和质量改进 (QI)；结合家庭监控以增强自我保护 管理;促进治疗启动和修改的决策支持工具；和每月审核/ 反馈会议以支持持续的 QI。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，以适应当地的能力、机会和 动机，目标 UG1)；准备（加强实施科学的能力，目标 UG2）； 通过阶梯式楔形集群试验实施和评估干预方案并评估两者 实施（例如，覆盖范围、采用、忠诚度）和有效性（例如，控制血压[主要 PLWH 和 HTN 中的结果]，目标 UH1； 24 个月后衡量可持续性和成本（其中 12 将交付从研究转移到当地工作人员花费了几个月的时间（Aim UH2）；并制定扩大规模的战略 直至农村诊所和全国（目标 UH3）。该项目的总体目标是采用严格的实证方法 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： 在项目期间持续的利益相关者关系和研究的共同所有权；完成三个 实施科学博士；通过高影响力的出版物和演讲传播研究结果。 我们还将参与 NHLBI 旨在加强研究的多机构协作网络 方法和对所有地点的影响，并促进下一代科学领导者的培训。