Scaling Out and Scaling Up the Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis andCare Cascade for HIV-infected Individuals (SCALE SAIA HTN)

未经诊断和治疗的高血压(HTN)是心血管疾病的主要驱动因素，导致 全球三分之一的死亡，对低收入和中等收入国家的影响不成比例。在整个SSA，国家- 基于证据的指南在筛查和管理HTN方面的应用水平较低，而且由于缺乏 服务准备情况，卫生工作者积极性参差不齐，卫生工作者问责制度薄弱，以及糟糕 将HTN筛查和管理与慢性护理服务相结合。在莫桑比克，那里的艾滋病毒 流行率为13%，艾滋病毒治疗平台是唯一规模化的慢性护理服务。有90多万人 患者接受抗逆转录病毒治疗，这为标准化和扩大HTN护理级联提供了机会 服务。低成本的系统级战略在改进链接的级联服务方面是有效的，并可能 有效地在现有艾滋病毒服务中实现HTN诊断和管理的常规化；改善通过 HTN级联；以及改善患者水平的结果。 我们的建议建立在正在进行的SAIA-HTN试验的基础上。我们的UG3/UH3(SAIA-量表)的总体目标 HTN)的目的是基于多组件实施战略的有效性建立可靠的证据基础 (SAIA)在HTN/HIV梯级上使用“横向扩展”框架，借此可以“借用”力量 先前的有效性试验。Scale SAIA-HTN将通过一种按地区交付的新模式进行横向扩展 卫生监督员(而不是学习护士)。我们还将扩大SAIA-HTN的规模，将其扩展到 另外两个省(15个区)，作为全国扩大规模的基础。我们提出了三个目标 UG3(规划)和两个UH3(实施)阶段。UG3-目标1：制定多部门 与主要利益攸关方建立伙伴关系，并在国家一级和与 参与省份。UG3-目标2：确定可能影响采用的关键促进者和障碍， 整合、扩大和维持SAIA-HTN实施战略。UG3-目标3：开展 评估地区主管领导的SAIA-HTN干预的可行性和可接受性的初步研究 在一个初级保健设施中呆上几个月，并根据需要重新设计工具和标准操作程序 UH3相。UH3-目标1：制定一项以地区为基础的传播和执行战略-- HTN使用RE-AIM模型来评估计划的覆盖范围、有效性、采用率、实施和 维修。UH3-目标2：确定用于护理级联优化的规模SAIA-HTN的成本。我们会 估计将HTN诊断和管理整合到HIV护理中的总增量和单位成本。

Undiagnosed and untreated hypertension (HTN) is a main driver of cardiovascular disease, contributing to a third of deaths globally, disproportionately affecting low and middle-income countries. Across sSA, country- level application of evidence-based guidelines to screen and manage HTN is low and variable due to lack of service readiness, uneven health worker motivation, weak health worker accountability systems, and poor integration of HTN screening and management with chronic care services. In Mozambique, where HIV prevalence is >13%, the HIV treatment platform is the only scaled chronic care service. With over 900,000 patients on anti-retroviral therapy, it presents an opportunity to standardize and scale HTN care cascade services. Low-cost, systems-level strategies are effective in improving linked cascade services and may be effective for routinizing HTN diagnosis and management within existing HIV services; improving flow through the HTN cascade; and improving patient-level outcomes. Our proposal builds on the ongoing SAIA-HTN trial. The overall objective of our UG3/UH3 (SCALE SAIA- HTN) is to establish a robust evidence base on the effectiveness of a multi-component implementation strategy (SAIA) on the HTN/HIV cascade using a ‘scaling-out’ framework, whereby strength can be ‘borrowed’ from prior effectiveness trials. SCALE SAIA-HTN will be ‘scaled out’ through a novel modality delivered by district health supervisors (rather than study nurses). We will also ‘scale up’ SAIA-HTN by expanding to all districts in two additional provinces (15 districts), serving as a foundation for national scale-up. We propose three aims for the UG3 (Planning) and two for UH3 (Implementation) phases. UG3-Aim 1: To develop a multi-sectoral partnership of key stakeholders and establish HTN technical working groups at the national level and with participating provinces. UG3-Aim 2: To identify key facilitators and barriers that could affect the adoption, integration, scale-up and sustainment of the SAIA-HTN implementation strategy. UG3-Aim 3: To conduct a pilot study to assess feasibility and acceptability of the district supervisor-led SAIA-HTN intervention over six months in one primary care facility and redesign tools and standard operating procedures as necessary for the UH3 phase. UH3-Aim 1: Develop a district-based dissemination and implementation strategy for SCALE SAIA- HTN using the RE-AIM model to evaluate the programs’ Reach, Effectiveness, Adoption, Implementation and Maintenance. UH3-Aim 2: Determine the costs of SCALE SAIA-HTN for care cascade optimization. We will estimate total incremental and unit costs of integrating HTN diagnosis and management into HIV care.