Table 1 Summary of the implementation strategies designed to support HIV/HTN care integration and their related outcome measures
Strategy | Components | Outcome measure |
|---|---|---|
Healthcare Provider HTN/CVD curriculum & Training | • Adaptation of an old MoH HTN management protocol, Botswana primary care guidelines [27] plus the Centers for Disease Control and Prevention (CDC, USA) Hypertension Management Curriculum [28] • Workshops materials developed using principles of interprofessional education • Online course of ten modules with pre- and post-test assessments • Post-workshop training was followed with on-site clinic mentoring through coaching and practice facilitation | • absolute difference in systolic and diastolic BP between baseline and 12-months visit • the proportion of participants who scored > 70% on the HDFQ • proportion of those who received CVD risk factor counselling on anti-HTN medication, healthy diet and appropriate physical activity levels • proportion prescribed guideline concordant BP medication (as per Botswana 2017 Primary Care Guideline and/or major publication on management of BP among Black Africans |
EHR adaptation | • Adaption of a locally developed MoH EHR system referred to as “PIMS”, to include the following ◦ Addition of reminders to record BP and weight; screen and counsel patients about physical activity, salt intake, and weight management; obtain a lipid profile if on protease inhibitor; obtain a lipid profile if > 50 years old and none is documented from the preceding 5 years ◦ EHR programming so that CVD risk prediction can occur automatically in the EHR when all the required input variables from the preceding 24 months are available | • proportion of clinic encounters in EHR (at the 12 months visit) where anti-HTN medications are prescribed if indicated, extracted from the HIV clinic EHR (E-prescribing) • proportion of PWH and HTN with 10-year CVD risk documented in EHR (E-CVDRF eval) • proportion with BP documented in EHR |
Treatment Partners | • Participants were paired with self-selected community-based treatment partners (from patient’s social network) ◦ Treatment partners practiced role-plays with trainers/counselors informed by motivational interviewing strategies • Treatment partners trained on HTN/CVD care • Role of treatment partner: ◦ communicate at least weekly with participant to provide counselling ◦ support on medication adherence and attending clinic appointments, HTN knowledge, and healthy diet and exercise | • proportion of participants with a treatment partner • proportion of treatment partners trained per protocol • proportion providing support with the same frequency as expected |