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

点击翻译按钮获取中文摘要

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.