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Abstract：
BACKGROUND: The burden of hypertension among people with HIV is high, particularly in low-and middle-income countries, yet gaps in hypertension screening and care in these settings persist. This study aimed to identify facilitators of and barriers to hypertension screening, treatment, and management among people with HIV in primary care clinics in Johannesburg, South Africa. Additionally, different stakeholder groups were included to identify discordant perceptions.
METHODS: Using a cross-sectional study design, data were collected via interviews (n = 53) with people with HIV and hypertension and clinic managers and focus group discussions (n = 9) with clinic staff. A qualitative framework analysis approach guided by COM-B and the Theoretical Domains Framework were used to identify and compare determinants of hypertension care across stakeholder groups.
RESULTS: Data from clinic staff and managers generated three themes characterizing facilitators of and barriers to the adoption and implementation of hypertension screening and treatment: 1) clinics have limited structural and operational capacity to support the implementation of integrated care models, 2) education and training on chronic care guidelines is inconsistent and often lacking across clinics, and 3) clinicians have the goal of enhancing chronic care within their clinics but first need to advocate for health system characteristics that will sustainably support integrated care. Patient data generated three themes characterizing existing facilitators of and barriers to clinic attendance and chronic disease self-management: 1) the threat of hypertension-related morbidity and mortality as a motivator for lifestyle change, 2) the emotional toll of clinic\'s logistical, staff, and resource challenges, and 3) hypertension self-management as a patchwork of informational and support sources. The main barriers to hypertension screening, treatment, and management were related to environmental resources and context (i.e., lack of enabling resources and siloed flow of clinic operations) and patients\' knowledge and emotions (i.e., lack of awareness about hypertension risk, fear, and frustration). Clinical actors and patients differed in perceived need to prioritize HIV versus hypertension care.
CONCLUSIONS: The convergence of multi-stakeholder data highlight key areas for improvement, where tailored implementation strategies targeting motivations of clinic staff and capacity of patients may address challenges to hypertension screening, treatment, and management recognized across groups.
METHODS: Using a cross-sectional study design, data were collected via interviews (n = 53) with people with HIV and hypertension and clinic managers and focus group discussions (n = 9) with clinic staff. A qualitative framework analysis approach guided by COM-B and the Theoretical Domains Framework were used to identify and compare determinants of hypertension care across stakeholder groups.
RESULTS: Data from clinic staff and managers generated three themes characterizing facilitators of and barriers to the adoption and implementation of hypertension screening and treatment: 1) clinics have limited structural and operational capacity to support the implementation of integrated care models, 2) education and training on chronic care guidelines is inconsistent and often lacking across clinics, and 3) clinicians have the goal of enhancing chronic care within their clinics but first need to advocate for health system characteristics that will sustainably support integrated care. Patient data generated three themes characterizing existing facilitators of and barriers to clinic attendance and chronic disease self-management: 1) the threat of hypertension-related morbidity and mortality as a motivator for lifestyle change, 2) the emotional toll of clinic\'s logistical, staff, and resource challenges, and 3) hypertension self-management as a patchwork of informational and support sources. The main barriers to hypertension screening, treatment, and management were related to environmental resources and context (i.e., lack of enabling resources and siloed flow of clinic operations) and patients\' knowledge and emotions (i.e., lack of awareness about hypertension risk, fear, and frustration). Clinical actors and patients differed in perceived need to prioritize HIV versus hypertension care.
CONCLUSIONS: The convergence of multi-stakeholder data highlight key areas for improvement, where tailored implementation strategies targeting motivations of clinic staff and capacity of patients may address challenges to hypertension screening, treatment, and management recognized across groups.
摘要：
背景：艾滋病毒感染者的高血压负担很高，特别是在中低收入国家，然而,在这些环境中,高血压筛查和护理方面的差距仍然存在.本研究旨在确定高血压筛查的促进者和障碍，治疗,以及约翰内斯堡初级保健诊所艾滋病毒感染者的管理，南非。此外,不同的利益相关者群体被包括在内，以识别不一致的看法。
方法：使用横断面研究设计，数据通过与HIV感染者和高血压患者以及诊所管理者的访谈(n=53)和与诊所工作人员的焦点小组讨论(n=9)收集.以COM-B和理论域框架为指导的定性框架分析方法用于识别和比较利益相关者群体中高血压护理的决定因素。
结果：来自诊所工作人员和管理人员的数据产生了三个主题，这些主题表征了采用和实施高血压筛查和治疗的促进者和障碍：1）诊所在支持实施综合护理模式方面的结构和运营能力有限，2)关于慢性护理指南的教育和培训不一致，而且在诊所之间往往缺乏，和3）临床医生的目标是在其诊所内加强慢性护理，但首先需要倡导卫生系统特征，以可持续地支持综合护理。患者数据产生了三个主题，这些主题表征了就诊和慢性病自我管理的现有促进者和障碍：1）与高血压相关的发病率和死亡率的威胁是生活方式改变的动力，2)诊所后勤的情感损失，工作人员,和资源挑战，3）高血压的自我管理是信息和支持来源的拼凑而成。高血压筛查的主要障碍，治疗,和管理与环境资源和环境相关(即，缺乏扶持资源和诊所运营的孤岛流动)和患者的知识和情绪(即，缺乏对高血压风险的认识，恐惧,和挫败感）。临床参与者和患者在认为需要优先考虑HIV和高血压护理方面存在差异。
结论：多利益相关方数据的融合突出了需要改进的关键领域，针对诊所工作人员的动机和患者能力的量身定制的实施策略可能会解决高血压筛查的挑战，治疗,和管理层跨群体认可。
方法：使用横断面研究设计，数据通过与HIV感染者和高血压患者以及诊所管理者的访谈(n=53)和与诊所工作人员的焦点小组讨论(n=9)收集.以COM-B和理论域框架为指导的定性框架分析方法用于识别和比较利益相关者群体中高血压护理的决定因素。
结果：来自诊所工作人员和管理人员的数据产生了三个主题，这些主题表征了采用和实施高血压筛查和治疗的促进者和障碍：1）诊所在支持实施综合护理模式方面的结构和运营能力有限，2)关于慢性护理指南的教育和培训不一致，而且在诊所之间往往缺乏，和3）临床医生的目标是在其诊所内加强慢性护理，但首先需要倡导卫生系统特征，以可持续地支持综合护理。患者数据产生了三个主题，这些主题表征了就诊和慢性病自我管理的现有促进者和障碍：1）与高血压相关的发病率和死亡率的威胁是生活方式改变的动力，2)诊所后勤的情感损失，工作人员,和资源挑战，3）高血压的自我管理是信息和支持来源的拼凑而成。高血压筛查的主要障碍，治疗,和管理与环境资源和环境相关(即，缺乏扶持资源和诊所运营的孤岛流动)和患者的知识和情绪(即，缺乏对高血压风险的认识，恐惧,和挫败感）。临床参与者和患者在认为需要优先考虑HIV和高血压护理方面存在差异。
结论：多利益相关方数据的融合突出了需要改进的关键领域，针对诊所工作人员的动机和患者能力的量身定制的实施策略可能会解决高血压筛查的挑战，治疗,和管理层跨群体认可。
