Managing Hypertension Among People Living With HIV

Conditions

Acquired Immunodeficiency Syndrome, Blood Pressure, Human Immunodeficiency Virus I Infection, Hypertension

Keywords

Noncommunicable Diseases, Cardiovascular Diseases, Health Services Accessibility, HIV, Nigeria

Brief summary

The Managing Hypertension Among People Living with HIV: An InTegrated Model (MAP-IT) a stepped wedge, cluster-randomized controlled trial to evaluate the effect of practice facilitation (PF) on the integration of a Task-Shifting Strategy for hypertension (HTN) control (TASSH) into HIV care for management of HTN in people living with HIV (PLWH). The study will recruit 960 PLWH across 30 primary health centers (PHCs) in Akwa Ibom State (32 patients/PHC).

Detailed description

People Living with HIV (PLWH) are at increased risk for non-communicable diseases (NCDs) including cardiovascular diseases (CVD) with hypertension (HTN) the most common. Integrating NCD management into HIV chronic care services may be a cost-effective strategy to mitigate the rising burden of NCDs in PLWH. The goal of the study is to evaluate the effectiveness of practice facilitation in the integration of a task-shifting strategy for hypertension control into HIV care service delivered in primary health centers in Akwa Ibom State, Nigeria. This study will occur in two phases: 1) The first phase is a UG3 Planning Phase during which investigators will use the iPARiHS implementation science framework to explore factors and support systems required for successful implementation and integration of TASSH into existing HIV chronic care platform and development of a context-specific practice facilitation strategy. 2) The second phase, which is the focus of this record, is a UH3 Implementation Phase during which we will use a stepped-wedge, cluster RCT, guided by the RE-AIM implementation science framework, to evaluate the effect of practice facilitation strategy on the level of adoption of TASSH, hypertension control, and level of sustainment of TASSH in management of hypertension among 960 patients enrolled in HIV treatment services across 30 PHCs.

Erinn M. Hade, Daniel Henry, Angela Aifah, Calvin L. Colvin, Shivani Mishra et al. (13 authors)

BMC Family Practice2026-09-05

10.1186/s12875-026-03531-y

Study design and protocol of a stepped wedge cluster randomized trial using a practical implementation strategy as a model for hypertension-HIV integration - the MAP-IT trial.

Aifah AA, Hade EM, Colvin C, Henry D, Mishra S, Rakhra A, Onakomaiya D, Ekanem A, Shedul G, Bansal GP, Lew D, Kanneh N, Osagie S, Udoh E, Okon E, Iwelunmor J, Attah A, Ogedegbe G, Ojji D.

2023-05-107 citations

10.1186/s13012-023-01272-5

Organizational readiness to implement task-strengthening strategy for hypertension management among people living with HIV in Nigeria.

Iwelunmor J, Ogedegbe G, Dulli L, Aifah A, Nwaozuru U, Obiezu-Umeh C, Onakomaiya D, Rakhra A, Mishra S, Colvin CL, Adeoti E, Badejo O, Murray K, Uguru H, Shedul G, Hade EM, Henry D, Igbong A, Lew D, Bansal GP, Ojji D.

2023-05-044 citations

10.1186/s43058-023-00425-3

Interventions

OTHERNurse-led Task-Shifting Strategy for Hypertension Control (TASSH) plus Practice Facilitation.

* TASSH includes CVD risk assessment; medication initiation and titration; lifestyle counseling and patient referral to physician care for complex cases. * Practice Facilitation includes the training of external experts to support the HIV nurses implementing TASSH

Study design

Allocation

RANDOMIZED

Intervention model

SINGLE_GROUP

Primary purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Intervention model description

Step wedge design. One group with a cross over.

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

No

Inclusion criteria

1. Persons aged 18 years or older 2. Be HIV positive and currently enrolled in HIV treatment services at one of the 30 study PHCs, be receiving HTN treatment services at one of the 30 study PHCs, or can be enrolled at one of the 30 study PHCs to receive HTN services for the entire study duration. 3. Have elevated blood pressure between 140-179 mm Hg systolic and/or 90-109 mm Hg diastolic, as determined by the average of the latter two of three separate BP readings during one clinic visit 4. Able to provide consent

Exclusion criteria

1. BP ≥180/100 mm Hg 2. Known history of kidney disease, heart disease, diabetes mellitus, stroke 3. A female who is pregnant or breastfeeding at the time of enrollment 4. Inability to provide informed consent 5. Refusal to participate in the study

Design outcomes

Primary

Measure	Time frame	Description
The effect of practice facilitation on the rate of adoption of a task sharing and strengthening strategy (TASSH).	12 months	TASSH is defined as: i identification of patients with uncontrolled hypertension; ii measurement of blood pressure and anthropometrics; iii initiation of lifestyle counselling and blood pressure medications; iv. referral of complicated patients

Secondary

Measure	Time frame	Description
Level of adoption and implementation fidelity of task sharing and strengthening for hypertension.	12 months	We will evaluate the level of adoption and implementation fidelity of TASSH as potential mechanisms that may explain the effect of PF on our primary outcome of BP control and change in systolic BP (SBP) from baseline to 12 months.
Level of sustainment of TASSH	6 months	We will evaluate the level of sustainment of TASSH at the end of the 6-month follow- up period.

Countries

Nigeria

Outcome results

None listed