Integrated Community-based Treatment of HIV and Hypertension in Zambia

摘要 据估计，在撒哈拉以南非洲的2180万艾滋病毒感染成年人中，有10-30%患有高血压， 心血管疾病（CVD）的最大风险因素。未经治疗的高血压的后果是 在经历CVD事件的风险比HIV高50%的HIV感染者中放大- 未感染的人，即使在控制了传统的CVD风险因素后。虽然艾滋病的规模扩大 治疗意味着数百万患者现在与卫生系统接触， 在这些相同的人群中，高血压治疗仍然存在。结果，只有不到10%的高血压患者 接受艾滋病毒治疗的患者血压得到控制。因为艾滋病毒和高血压管理共享 许多屏障（例如，获得护理的机会成本），艾滋病毒治疗的新兴解决方案也代表了 改善非洲其他慢性病治疗的可及性和可持续性的关键机遇。 拟议的K23研究旨在了解增加高血压的可实施性和影响。 在赞比亚，艾滋病毒治疗的“社区坚持小组”（CAG）模式被纳入艾滋病毒治疗。在目标1中，我们 通过测量采用率、忠诚度、 实施和可持续性，随着时间的推移获得高血压药物。在目标2中，我们将使用 之前和之后的设计，以评估引入的做法对血压的有效性。在目标3中， 将在医护人员和患者中进行深入访谈和焦点小组，以了解 优化模型的可接受性、适应性和可及性，以便将来传播并最终扩展到 未感染艾滋病毒的高血压人群。我目前正沉浸在一个由该法案支持的项目中， 梅林达·盖茨基金会致力于在赞比亚实施和推广CAG艾滋病毒治疗模式。 我对CAG实施的实践知识将使高血压组件添加到 CAG模型立即可行。所提出的科学目标的结果将为R 01评估 传播艾滋病毒和高血压综合治疗CAG模型和R21，以扩大该模型， 未感染艾滋病毒的患者。 这个建议的指导职业发展奖的总体目标是支持我的发展， 一位独立的实施科学研究员，专注于慢性病的卫生系统创新。 在资源有限的情况下防治疾病。K23的职业发展目标是获得以下方面的专业知识： 实施科学理论在研究设计和评价中的应用;（2）研究设计和评价的分析方法 相关和纵向数据;（3）在实施研究中使用定性方法;（4） 定位研究问题和研究结果，以优化对实践和政策的影响。这个计划将是 在具有艾滋病毒和艾滋病专业知识的国际导师团队的课程和指导下开展， 心血管疾病流行病学、实施科学、生物统计学和混合方法研究。

ABSTRACT An estimated 10-30% of the 21.8 million HIV-infected adults in sub-Saharan Africa have hypertension, the single largest risk factor for cardiovascular disease (CVD). The consequences of untreated hypertension are magnified in HIV-infected individuals who are at 50% greater risk of experiencing a CVD event than HIV- uninfected persons, even after controlling for traditional CVD risk factors. Although the scale up of HIV treatment means that millions of patients are now in contact with the health system, poor uptake of hypertension treatment in these same populations persists. As a result, fewer than 10% of hypertensive patients on HIV treatment have controlled blood pressure. Because HIV and hypertension management share many barriers (e.g., opportunity costs of accessing care), emerging solutions for HIV treatment also represent critical opportunities to improve access to, and sustainability of, treatment for other chronic conditions in Africa. The proposed K23 study seeks to understand the implementability and effects of adding hypertension treatment into the “community adherence group” (CAG) model for HIV treatment in Zambia. In Aim 1, we will evaluate the implementation of the hypertension care into this model by measuring adoption, fidelity of implementation, and sustainability of access to hypertension medications over time. In Aim 2, we will use a before-and-after design to evaluate the effectiveness of introduced practices on blood pressure. In Aim 3, we will use in-depth interviews and focus groups among both health care workers and patients to understand how to optimize the acceptability, fit, and reach of the model for future dissemination and eventual extension into HIV-uninfected populations with hypertension. I am currently immersed in a project supported by the Bill and Melinda Gates Foundation that seeks to implement and scale up the CAG model for HIV treatment in Zambia. My hands-on knowledge of CAG implementation will make the addition of a hypertension component into the CAG model immediately feasible. Findings from the scientific aims proposed will inform an R01 evaluating the dissemination of an integrated HIV and hypertension treatment CAG model and an R21 to expand the model to HIV-uninfected patients. The overarching goal of this proposed mentored career development award is to support my development into an independent implementation science researcher with a focus on health systems innovations for chronic diseases in resource-limited settings. The career development aims for this K23 are to obtain expertise in (1) the application of implementation science theory to research design and evaluation; (2) analytic methods for correlated and longitudinal data; (3) the use of qualitative methods in implementation research and (4) positioning research questions and findings to optimize influence on practice and policy. This plan will be carried out with coursework and guidance of an international team of mentors with expertise in HIV & cardiovascular disease epidemiology, implementation science, biostatistics, and mixed methods research.