Integration of a task strengthening strategy for hypertension management into HIV care in Nigeria: a cluster randomized controlled trial study protocol

Aifah, Angela; Odubela, Oluwatosin; Rakhra, Ashlin; Onakomaiya, Deborah; Hu, Jiyuan; Nwaozuru, Ucheoma; Oladele, David; Odusola, Aina Olufemi; Idigbe, Ifeoma; Musa, Adesola Z.; Akere, Ayodeji; Tayo, Bamidele O.; Ogedegbe, Gbenga; Iwelunmor, Juliet; Ezechi, Oliver

doi:10.1186/s13012-021-01167-3

Cited by 9 publications

(15 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For low-resource-high-need settings, overwhelmed by suboptimal healthcare systems and healthcare workforce shortage, context-specific approaches for integrating effective, evidence-based approaches are critically needed [ 16 , 25 ]. Our study, MAP-IT, is one of few implementation science studies to include a health services’ strengthening implementation strategy approach to integrate hypertension management into HIV care and treatment in Akwa Ibom State, Nigeria, which has one of the highest HIV prevalence rates in the country.…”

Section: Discussionmentioning

confidence: 99%

“…As previously noted, our Lagos study [ 16 ] provides thorough details of TASSH and the approach for developing the PF implementation strategy. Here, we briefly describe both and specify any potential differences for this study.…”

Section: Methodsmentioning

confidence: 99%

“…The four steps are defined as follows: (1) identifying PLWH patients with uncontrolled hypertension ( BP > 140/90); (2) initiating counseling by giving clear advice on how PLWH patients can modify their behaviors; (3) treating PLWH with uncontrolled hypertension by prescribing medication treatment according to the Nigerian Simplified Hypertension Protocol; and (4) referring patients with severely elevated BP and/or a chronic comorbid condition, including established CVD, to physicians for further care. The 5 As have been implemented in previous TASSH studies [ 11 , 16 , 17 , 25 ] and applied to other health outcomes [ 33 , 34 ].…”

Section: Methodsmentioning

confidence: 99%

“…Development of the PF strategy included the following: (1) training the practice facilitators using a train-the-trainer model [ 35 ] guided by the study-developed three Es, i.e., engaging, enhancing, and evaluating the nurses on performing their TASSH duties and delivering the hypertension protocol, (2) identifying site champions and coordinators, (3) building consensus for quality improvement targets, (4) implementing practice changes to support TASSH implementation, and (5) peer-to-peer collaboration. Additional details on the training approach for TASSH and the PF implementation strategy are detailed in prior work [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…We aim to evaluate the effectiveness of practice facilitation (PF) on the integration of a task-strengthening strategy for hypertension control (TASSH) in PHCs in Akwa Ibom. While similar to an ongoing study in Lagos [ 16 ], this study is conducted in collaboration with the Agency and features several distinctions, notably the implementation science framework and study design applied. Below, we (1) provide an overview of the hypertension program and implementation strategy, (2) discuss the implementation science frameworks used, and (3) detail the study design and analysis for this implementation science protocol.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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,

Hade,

Colvin

et al. 2023

Implementation Sci

Self Cite

View full text Add to dashboard Cite

Background As people living with HIV (PLWH) experience earlier and more pronounced onset of noncommunicable diseases (NCDs), advancing integrated care networks and models in low-resource-high-need settings is critical. Leveraging current health system initiatives and addressing gaps in treatment for PLWH, we report our approach using a late-stage (T4) implementation research study to test the adoption and sustainability of a proven-effective implementation strategy which has been minimally applied in low-resource settings for the integration of hypertension control into HIV treatment. We detail our protocol for the Managing Hypertension Among People Living with HIV: an Integrated Model (MAP-IT) trial, which uses a stepped wedge cluster randomized trial (SW-CRT) design to evaluate the effectiveness of practice facilitation on the adoption of a hypertension treatment program for PLWH receiving care at primary healthcare centers (PHCs) in Akwa Ibom State, Nigeria. Design In partnership with the Nigerian Federal Ministry of Health (FMOH) and community organizations, the MAP-IT trial takes place in 30 PHCs. The i-PARiHS framework guided pre-implementation needs assessment. The RE-AIM framework will guide post-implementation activities to evaluate the effect of practice facilitation on the adoption, implementation fidelity, and sustainability of a hypertension program, as well as blood pressure (BP) control. Using a SW-CRT design, PHCs sequentially crossover from the hypertension program only (usual care) to hypertension plus practice facilitation (experimental condition). PHCs will recruit and enroll an average of 28–32 patients to reach a maximum of 960 PLWH participants with uncontrolled hypertension who will be followed longitudinally for BP outcomes. Discussion Given the need for integrated NCD-HIV care platforms in low-resource settings, MAP-IT will underscore the challenges and opportunities for integrating hypertension treatment into HIV care, particularly concerning adoption and sustainability. The evaluation of our integration approach will also highlight the potential impact of a health systems strengthening approach on BP control among PLWH. Trial registration Clinicaltrials.gov (NCT05031819). Registered on 2nd September 2021.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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,

Hade,

Colvin

et al. 2023

Implementation Sci

Self Cite

View full text Add to dashboard Cite

show abstract

Moving toward equity: fostering transdisciplinary research between the social and behavioral sciences and implementation science to end the HIV epidemic

Pyra

Motley

Bouris

2022

Current Opinion in HIV and AIDS

View full text Add to dashboard Cite

Purpose of reviewSince the beginning of the HIV epidemic, social and behavioral scientists have developed interventions to stem the spread of the virus. The dissemination of these interventions has traditionally been a lengthy process; however, implementation science (IS) offers a route toward hastening delivery of effective interventions. A transdisciplinary approach, wherein IS informs and is informed by social and behavioral sciences (SBS) as well as community participation, offers a strategy for more efficiently moving toward health equity and ending the HIV epidemic. Recent findingsThere has been considerable growth in HIV research utilizing IS theories, methods and frameworks. Many of these studies have been multi or interdisciplinary in nature, demonstrating the ways that IS and SBS can strengthen one another. We also find areas for continued progress toward transdisciplinarity.

show abstract

Training primary healthcare workers on a task-strengthening strategy for integrating hypertension management into HIV care in Nigeria: implementation strategies, knowledge uptake, and lessons learned

Oladele,

Odusola,

Odubela

et al. 2023

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background With improved access to anti-retroviral drugs, persons living with HIV/AIDS (PLWHA) are living longer but with attendant increased risks of non-communicable diseases (NCDs). The increasing burden of NCDs, especially hypertension, could reverse gains attributed to HIV care. Nurses and Community Health Officers (CHO) in Nigeria are cardinal in delivering primary health care. A task-strengthening strategy could enable them to manage hypertension in HIV care settings. This study aimed to assess their knowledge and practice of hypertension management among Healthcare workers (HCWs) and to explore the challenges involved in conducting onsite training during pandemics. Methods Nurses and CHOs in the employment of the Lagos State Primary Health Care Board (LSPHCB), Lagos State, Nigeria, were recruited. They were trained through hybrid (virtual and onsite) modules before study implementation and a series of refresher trainings. A pre-and post-training test survey was administered, followed by qualitative interviews to assess skills and knowledge uptake, the potential barriers and facilitators of task-sharing in hypertension management in HIV clinics, and the lessons learned. Results Sixty HCWs participated in the two-day training at baseline. There was a significant improvement in the trainees' knowledge of hypertension management and control. The average score during the pre-test and post-test was 59% and 67.6%, respectively. While about 75% of the participants had a good knowledge of hypertension, its cause, symptoms, and management, 20% had moderate knowledge, and 5% had poor knowledge at baseline. There was also an increase in the mean score between the pre-test and post-test of the refresher training using paired t-tests (P < 0.05). Role-playing and multimedia video use improved the participants' uptake of the training. The primary barrier and facilitator of task sharing strategy in hypertension management reported were poor delineation of duties among HCWs and the existing task shifting at the Primary Healthcare Centres (PHC) level, respectively. Conclusions The task strengthening strategy is relevant in managing hypertension in HIV clinics in Nigeria. The capacity development training for the nurses and CHOs involved in the Integration of Hypertension Management into HIV Care in Nigeria: A Task Strengthening Strategy (TASSH-Nigeria) study yielded the requisite improvement in knowledge uptake, which is a reassurance of the delivery of the project outcomes at the PHCs.

show abstract

Integration of a task strengthening strategy for hypertension management into HIV care in Nigeria: a cluster randomized controlled trial study protocol

Cited by 9 publications

References 42 publications

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

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

Moving toward equity: fostering transdisciplinary research between the social and behavioral sciences and implementation science to end the HIV epidemic

Training primary healthcare workers on a task-strengthening strategy for integrating hypertension management into HIV care in Nigeria: implementation strategies, knowledge uptake, and lessons learned

Contact Info

Product

Resources

About