Community-taskpen approach for NCD multimorbidity response and engagement of PLHIV in zambia" ('carez') study - in the united states, non-communicable diseases (NCDS) now account for the majority of…

The National Institutes of Health Fogarty International Center awarded $548,242 to the Centre for Infectious Disease Research in Zambia on August 20, 2026, under the International Research and Research Training program (CFDA 93.989) to conduct the CAREZ study, a hybrid effectiveness-implementation cluster randomized stepped-wedge trial evaluating integrated screening and management of cardiometabolic noncommunicable diseases among people living with HIV in Zambia.

The study will implement the TASKPEN approach, an evidence-based package adapted from the WHO's Package of Essential Noncommunicable Disease Interventions that task-shifts care delivery to non-physician health workers. TASKPEN includes lifestyle counseling guides, treatment algorithms, point-of-care diagnostics, and protocols for multi-month dispensing of noncommunicable disease medications. The CAREZ model integrates mobile care teams led by community health workers within existing community health structures and is supported by mobile health technology. The trial will operate across 12 urban communities in Lusaka, Zambia, over the performance period ending May 31, 2031. Zambia was selected as the implementation site because of its established community HIV care platforms that can serve as an implementation laboratory; such platforms do not exist in the United States.

Community-taskpen approach for NCD multimorbidity response and engagement of PLHIV in zambia" ('carez') study - in the united states, non-communicable diseases (NCDS) now account for the majority of deaths among people living with HIV (PLHIV), with heart disease and cancer being the leading causes of death among american PLHIV over the age of 50 years. In response to the problem of cardiometabolic NCDS leading to heart disease in PLHIV, our team created a novel evidence-based package to manage HIV-NCD multimorbidity. This package, which we have coined 'taskpen,' is based on task-shifting an adapted version of who's package of essential noncommunicable disease interventions (pen) to non-physician health workers. Taskpen includes lifestyle counseling guides, easy-to-follow treatment algorithms, point-of-care diagnostics, and protocols for multi-month dispensing of NCD medications. Despite the availability of evidence-based practices like taskpen, however, integrated care remains out of reach for millions of people with multimorbidity from HIV and cardiometabolic NCDS in the US and globally. To address this GAP, we propose the "community-taskpen approach for NCD multimorbidity response and engagement of PLHIV in zambia (or 'carez') study. The carez study will focus on integrating mobile care teams, led by community health workers, within community health structures to deliver screening and management of cardiometabolic NCDS using taskpen and supported by mhealth technology-a novel model that we call 'carez'. To evaluate the effects of carez on control of both HIV and NCDS, as well as key implementation outcomes, we propose to conduct a hybrid effectiveness-implementation cluster randomized stepped-wedge trial in 12 urban communities of lusaka, zambia. Zambia is uniquely suited to study HIV-NCD multimorbidity because of its robust community HIV care platforms. These kinds of platforms simply DON't exist in the US and can serve as an implementation laboratory to develop cost-effective community-based approaches to prevent and treat the NCD risk factors leading to heart disease in PLHIV. The proposed research will generate knowledge directly applicable to american health by identifying a replicable, sustainable, and scalable solution to promote ideal cardiovascular health for PLHIV in the US and globally. This study can only feasibly be conducted in a setting with a high prevalence of both HIV and cardiometabolic NCDS, such as zambia, where sufficient numbers of people living with HIV and CO-morbid NCDS can be enrolled into a trial to ensure adequate power to generate scientifically robust evidence. The rigorous implementation science methods and outcome assessment we propose will also enable distillation of the carez model into its core components that can be directly adapted and applied to the US context. If effective, carez could reduce NCD multimorbidity for PLHIV, and create opportunities for implementation in the US safety net settings where the majority of PLHIV receive their healthcare, including ending the HIV epidemic (EHE) jurisdictions, community health centers, and federally qualified health centers receiving ryan white HIV/aids funding.