Cooperative Agreement UH3HL154501

PULESA-UGANDA-STRENGTHENING THE BLOOD PRESSURE CARE AND TREATMENT CASCADE FOR UGANDANS LIVING WITH HIV-IMPLEMENTATION STRATEGIES TO SAVE LIVES - PROJECT SUMMARY CHRONIC HIV INFECTION IS A WELL-ESTABLISHED RISK FACTOR FOR CARDIOVASCULAR DISEASE. IN SUB-SAHARAN AFRICA)-A REGION THAT MAY ACCOUNT FOR HALF OF THE GLOBAL BURDEN OF CVD ATTRIBUTABLE TO HIV-HYPERTENSION IS THE MOST IMPORTANT DRIVER OF CVD RISK. PROFOUND BARRIERS TO EFFECTIVE HYPERTENSION MANAGEMENT EXIST, INCLUDING LIMITED KNOWLEDGE, INCONSISTENT BP MEASUREMENT, AND POOR ACCESS TO MEDICATIONS. HIV CARE INNOVATIONS SUCH AS ACCESS TO NO-COST ANTIRETROVIRAL THERAPY, DIFFERENTIATED SERVICE DELIVERY AND USE OF PLHIV PEERS IN CARE MODELS MAY IMPROVE CARE OF COMORBID CONDITIONS SUCH AS HYPERTENSION. THE OVERARCHING GOAL OF PULESA-UGANDA STUDY IS TO IMPROVE THE BP TREATMENT CASCADE FOR PEOPLE LIVING WITH HIV (PLHIV) IN URBAN AND PERI-URBAN UGANDA IN A SCALABLE AND SUSTAINABLE MANNER. THIS HYBRID IS TYPE 3 STUDY PROPOSES TO FIRST EXPLORE CURRENT PRACTICE, ROUTINES, BARRIERS, AND FACILITATORS OF EVIDENCE-BASED BP CARE IN HIV CLINICAL SETTINGS IN KAMPALA AND WAKISO DISTRICTS (AIM 1). THEN, USING A HUMAN-CENTERED DESIGN APPROACH, A DESIGN TEAM OF KEY STAKEHOLDERS WILL USE DATA FROM THE FORMATIVE ASSESSMENT TO DEVELOP A MULTI-COMPONENT IMPLEMENTATION STRATEGY (HTN-PLUS) TO IMPROVE UPTAKE AND ADHERENCE TO EVIDENCE-BASED BP TREATMENTS, CONTEXTUALLY ADAPTED TO THESE UGANDAN HIV CLINICS (SUB-AIM 1.1). THE DESIGN TEAM WILL ADAPT DIFFERENTIATED SERVICE DELIVERY MODELS, USE OF HYPERTENSIVE PLHIV PEER CHAMPIONS, AND METHODS OF BP MONITORING THAT ADDRESS SPECIFIC BARRIERS AND FACILITATORS OF BP CARE. IN A STEPPED-WEDGE CLUSTER RANDOMIZED TRIAL OF 16 CLINICS FROM KAMPALA AND WAKISO, WE WILL DETERMINE THE EFFECTIVENESS OF IMPLEMENTATION STRATEGIES TO IMPROVE BP CASCADE METRICS (AIM 2). CLINICS WILL BE RANDOMIZED TO RECEIVE FREE AND CONSISTENT ACCESS TO DIAGNOSTIC EQUIPMENT AND EVIDENCE-BASED ANTIHYPERTENSIVE DRUGS (HTN-BASIC) WITH AND WITHOUT THE MULTI-COMPONENT IMPLEMENTATION STRATEGY DEVELOPED IN SUB-AIM 1 (HTN-PLUS). THE PRIMARY EFFECTIVENESS OUTCOME WILL BE % OF PATIENTS WITH HYPERTENSION DIAGNOSIS WHO ARE CONTROLLED (