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The Challenge (and Opportunity)

Cardiovascular disease is the leading cause of premature death in the world, yet people who have the disease often do not develop symptoms or realize that they have it until it causes a heart attack, stroke, or other catastrophic health issue. It is estimated that 15-40% of people living in sub-Saharan Africa have hypertension (high blood pressure), but most of them (60%–90%) are unaware of their condition.

Research has shown that people living with HIV (PLHIV) have higher rates of hypertension and cardiovascular disease than the general population. This is partly due to the inflammation caused by the virus itself, partly due to the medications they take to control the virus, and partly due to lifestyle and social factors. Unfortunately, health workers who regularly care for PLHIV in low- and middle-income countries often do not have the training or resources to screen for, treat, or consistently monitor their patients for hypertension.

Because of PEPFAR and other public and private initiatives to fight HIV/AIDS, millions of people around the world have access to lifesaving antiretroviral therapy (ART), which is offered for free or at a minimal cost in much of sub-Saharan Africa at HIV clinics. In recent years, researchers have tested interventions to integrate non-communicable disease care into these clinics alongside their regular HIV treatment services. Although various effective programs have been identified, they have received only limited adoption so far. There is a need for implementation science research to understand and overcome the barriers facing clinicians, health facilities, communities, and health policymakers that are preventing these effective interventions from being scaled up and used more widely.

The HLB-SIMPLe Alliance is working to generate quality evidence in six African countries to address this challenge.