Integration of Hypertension Management Into HIV Care in Nigeria
Integration of Hypertension Management Into HIV Care in Nigeria
This study evaluates a tailored-practice facilitation (PF) strategy for integrating a task
 strengthening strategy for hypertension control (TASSH) for the care of patients living with
 HIV (PWH) within primary health centers (PHCs) in Lagos, Nigeria.
Although access to antiretroviral therapy has led to increased survival among people living
 with HIV (PWH) in Africa, this population now has higher cardiovascular disease (CVD) -
 mortality than the general population largely due to an increased burden of hypertension. In
 Nigeria, the acute shortage of physicians limits the capacity to control hypertension among
 PWH at the primary care level where the majority receive treatment. This study proposes the
 use of practice facilitation (PF) - which will provide external expertise on practice
 redesign and a tailored approach to delivery of the evidence-based task strengthening
 strategy - to integrate hypertension into the HIV care model. Using a clinical-effectiveness
 implementation design, we will evaluate the effect of a PF strategy for integrating an
 evidence-based intervention for hypertension (HTN) control into HIV care among 960 patients
 with uncontrolled HTN in 30 primary health centers (PHCs) in Nigeria. Study is in 3 phases:
 1) a pre-implementation phase that will develop a tailored PF intervention for integrating
 TASSH into HIV clinics; 2) an implementation phase that will compare the clinical
 effectiveness of PF vs. a self-directed condition (receipt of information on TASSH without
 PF) on BP reduction; and 3) a post- implementation phase to evaluate the effect of PF vs.
 self-directed condition on the adoption and sustainability of TASSH. The PF intervention
 comprises: (a) an advisory board to provide leadership support for implementing TASSH in HIV
 clinics; (b) training of the HIV nurses on TASSH protocol; and (c) training of practice
 facilitators, who will serve as coaches, provide support, and performance feedback to the HIV
 nurses
Inclusion Criteria:

 -  Be an adult aged 18 years and older.

 -  Attends one of the 30 HIV clinics.

 -  Have a diagnosis of HTN with uncontrolled blood pressure, i.e. BP is 140-179/90-100 mm
 Hg.

 -  Ability to provide consent.

 Exclusion Criteria:

 -  BP>180/100 mm Hg;

 -  history of chronic kidney disease, heart disease, diabetes or stroke, pregnancy

 -  Inability to provide informed consent.

 -  Refusal to participate in the study.