PDF(Pubmed)
Abstract：
BACKGROUND: Successful HIV treatment programs have turned HIV into a chronic condition, but noncommunicable diseases such as hypertension jeopardize this progress. Hypertension control rates among people with HIV (PWH) are low owing to gaps in patient awareness, diagnosis, effective treatment, and management of both conditions at separate clinic visits. Integrated management, such as in our study, InterCARE, can enhance HIV-hypertension integration and blood pressure (BP) control.
METHODS: Our pilot study was conducted in two Botswana HIV clinics between October 2021 and November 2022. Based on our formative work, we adopted three main strategies; Health worker training on HTN/cardiovascular disease (CVD) management, adaptation of HIV Electronic Health Record (EHR) for HTN/CVD care, and use of treatment partners to support PWH with hypertension for implementation. We employed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to assess implementation effectiveness and outcomes for BP control at baseline, 6 and 12 months. HIV viral load (VL) suppression was also measured to assess impact of integration on HIV care.
RESULTS: We enrolled 290 participants; 35 (12.1%) were lost to follow-up, leaving 255 (87.9%) at 12-months. Median age was 54 years (IQR 46-62), and 77.2% were females. Our interventions significantly improved BP control to < 140/90 mmHg (or < 130/80 mmHg if diagnosis of diabetes or chronic kidney disease), from 137/290 participants, 47.2% at baseline to 206/290 participants, 71.0%, at 12 months (p < 0.001). Among targeted providers, 94.7% received training, with an associated significant increase in counseling on exercise, diet, and medication (all p < 0.001) but EHR use for BP medication prescribing and cardiovascular risk factor evaluation showed no adoption. In the intention-to-treat analysis, HIV VL suppression at 12 months decreased (85.5% vs 93.8%, p = 0.002) due to loss to follow-up but the per protocol analysis showed no difference in VL suppression between baseline and 12 months (97.3% vs 93.3%, p = 0.060).
CONCLUSIONS: The InterCARE pilot study demonstrated that low-cost practical support measures involving the integration of HIV and hypertension/CVD management could lead to improvements in BP control. These results support the need for a large implementation and effectiveness trial.
BACKGROUND: ClinicalTrials.gov NCT05414526. Registered 18th May 2022.
METHODS: Our pilot study was conducted in two Botswana HIV clinics between October 2021 and November 2022. Based on our formative work, we adopted three main strategies; Health worker training on HTN/cardiovascular disease (CVD) management, adaptation of HIV Electronic Health Record (EHR) for HTN/CVD care, and use of treatment partners to support PWH with hypertension for implementation. We employed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to assess implementation effectiveness and outcomes for BP control at baseline, 6 and 12 months. HIV viral load (VL) suppression was also measured to assess impact of integration on HIV care.
RESULTS: We enrolled 290 participants; 35 (12.1%) were lost to follow-up, leaving 255 (87.9%) at 12-months. Median age was 54 years (IQR 46-62), and 77.2% were females. Our interventions significantly improved BP control to < 140/90 mmHg (or < 130/80 mmHg if diagnosis of diabetes or chronic kidney disease), from 137/290 participants, 47.2% at baseline to 206/290 participants, 71.0%, at 12 months (p < 0.001). Among targeted providers, 94.7% received training, with an associated significant increase in counseling on exercise, diet, and medication (all p < 0.001) but EHR use for BP medication prescribing and cardiovascular risk factor evaluation showed no adoption. In the intention-to-treat analysis, HIV VL suppression at 12 months decreased (85.5% vs 93.8%, p = 0.002) due to loss to follow-up but the per protocol analysis showed no difference in VL suppression between baseline and 12 months (97.3% vs 93.3%, p = 0.060).
CONCLUSIONS: The InterCARE pilot study demonstrated that low-cost practical support measures involving the integration of HIV and hypertension/CVD management could lead to improvements in BP control. These results support the need for a large implementation and effectiveness trial.
BACKGROUND: ClinicalTrials.gov NCT05414526. Registered 18th May 2022.
摘要：
背景：成功的HIV治疗计划已将HIV转变为慢性疾病，但是高血压等非传染性疾病危害了这一进展。由于患者意识的差距，艾滋病毒感染者（PWH）的高血压控制率很低，诊断,有效治疗,以及在单独的诊所就诊时对这两种情况的管理。综合管理,比如在我们的研究中，InterCARE,可以增强HIV-高血压整合和血压（BP）控制。
方法：我们的试点研究于2021年10月至2022年11月在博茨瓦纳的两家HIV诊所进行。根据我们的形成工作，我们采取了三种主要策略；卫生工作者对HTN/心血管疾病(CVD)管理的培训，将HIV电子健康记录（EHR）用于HTN/CVD护理，并使用治疗伙伴支持PWH合并高血压的实施。我们雇佣了Reach,有效性,收养,实施,维护（RE-AIM）框架，以评估基线BP控制的实施有效性和结果，6和12个月。还测量了HIV病毒载量（VL）抑制，以评估整合对HIV护理的影响。
结果：我们招募了290名参与者；35名（12.1%）失去随访，在12个月时留下255人（87.9%）。中位年龄为54岁(IQR46-62)，77.2%为女性。我们的干预措施显着改善了血压控制<140/90mmHg（如果诊断为糖尿病或慢性肾脏疾病，则<130/80mmHg），来自137/290名参与者，206/290名参与者的基线为47.2%，71.0%,12个月时（p<0.001）。在目标提供商中，94.7%接受过培训，随着运动咨询的显著增加，饮食，和药物（均p<0.001），但用于BP药物处方和心血管危险因素评估的EHR未显示采用。在意向治疗分析中，12个月时的HIVVL抑制下降（85.5％vs93.8％，p=0.002）由于随访失败，但每个方案分析显示基线和12个月之间的VL抑制没有差异（97.3%vs93.3%，p=0.060)。
结论：InterCARE试点研究表明，涉及整合HIV和高血压/CVD管理的低成本实际支持措施可以改善BP控制。这些结果支持需要进行大规模的实施和有效性试验。
背景：ClinicalTrials.govNCT05414526。2022年5月18日注册。
方法：我们的试点研究于2021年10月至2022年11月在博茨瓦纳的两家HIV诊所进行。根据我们的形成工作，我们采取了三种主要策略；卫生工作者对HTN/心血管疾病(CVD)管理的培训，将HIV电子健康记录（EHR）用于HTN/CVD护理，并使用治疗伙伴支持PWH合并高血压的实施。我们雇佣了Reach,有效性,收养,实施,维护（RE-AIM）框架，以评估基线BP控制的实施有效性和结果，6和12个月。还测量了HIV病毒载量（VL）抑制，以评估整合对HIV护理的影响。
结果：我们招募了290名参与者；35名（12.1%）失去随访，在12个月时留下255人（87.9%）。中位年龄为54岁(IQR46-62)，77.2%为女性。我们的干预措施显着改善了血压控制<140/90mmHg（如果诊断为糖尿病或慢性肾脏疾病，则<130/80mmHg），来自137/290名参与者，206/290名参与者的基线为47.2%，71.0%,12个月时（p<0.001）。在目标提供商中，94.7%接受过培训，随着运动咨询的显著增加，饮食，和药物（均p<0.001），但用于BP药物处方和心血管危险因素评估的EHR未显示采用。在意向治疗分析中，12个月时的HIVVL抑制下降（85.5％vs93.8％，p=0.002）由于随访失败，但每个方案分析显示基线和12个月之间的VL抑制没有差异（97.3%vs93.3%，p=0.060)。
结论：InterCARE试点研究表明，涉及整合HIV和高血压/CVD管理的低成本实际支持措施可以改善BP控制。这些结果支持需要进行大规模的实施和有效性试验。
背景：ClinicalTrials.govNCT05414526。2022年5月18日注册。
