Written by April Houston, MPH, MSW

About one-third of adults between the ages of 30-79 globally have hypertension, a dangerous medical condition the WHO recently called a “silent killer”.

It is true that many people with hypertension do not realize they have it until they experience a severe medical event. Hypertension brings with it an increased risk for stroke, heart attack, and kidney failure as the pressure in arteries is higher than it should be, causing the heart to work harder than necessary to circulate blood throughout the body. Hypertension is one of the top causes of death worldwide and its prevalence continues to grow.

A population of increasing concern for hypertension and cardiovascular disease are people living with HIV (PLHIV). Thanks to substantial financial and scientific investment in understanding and combatting HIV in recent decades and the invention and widespread availability of antiretroviral therapy (ART), many people with HIV are surviving into their senior years; and like most older adults, they are developing chronic health issues. PLHIV are actually more likely than the HIV-negative population to have hypertension, more likely to have a cardiovascular event, and have a higher risk of mortality overall.

In sub-Saharan Africa, home to two-thirds of the global population of PLHIV, most HIV health care services are delivered in specialized clinics. Although these HIV clinics are great resources for regular exams and ART medication distribution, clinicians there may not have the ability nor resources to screen for and treat other medical conditions, requiring people with multiple comorbidities to visit several different health facilities to get all the services they need (assuming, of course, they know they have other conditions in need of treatment).

New research, including the INTE-AFRICA trial, is increasingly touting the benefits of integrated healthcare services as an alternative to the standard vertical approach to HIV and chronic disease management. While the appeal of this approach is obvious from the patient perspective (who wouldn’t want to have fewer medical appointments?), the feasibility of it from a clinician and health system perspective is less well understood.

Imagine that you run an HIV clinic in Zambia, and you decide to change your model to one of integrated care. How do you go about it? What equipment and procedures must be in place to enable your clinic to offer care for hypertension and other chronic diseases on top of existing services? Do the clinicians have the right training and expertise? How will these additional services affect staff workloads? Are medications to manage chronic diseases available and affordable in these settings? What type of recordkeeping upgrades are needed? How much will these new services cost and who will pay for them? 

These are important questions, and the HLB-SIMPLe Alliance, with funding from the National Heart, Lung, and Blood Institute (NHLBI), is trying to answer them with implementation science. Through six different large-scale trials in Botswana, Mozambique, Nigeria, South Africa, Uganda, and Zambia, our researchers are testing different strategies designed to improve screening for and management of hypertension and other cardio-metabolic diseases in health facilities that routinely treat PLHIV. Each trial is structured differently, but many of the strategies being tested are similar: training health providers and educating patients on chronic disease management, shifting certain tasks from physicians to other  health workers, introducing electronic health records, providing diagnostic equipment and antihypertensive drugs, among others.

These studies are being led by researchers at African universities in partnership with American universities, civil society organizations, and relevant Ministries of Health to ensure these groups are aware of what we are learning and understand how our findings affect them . HLB-SIMPLE’s Research Coordinating Center (RCC) is providing organizational, administrative, and communications, and technical support to all the trials and will be offering regular updates through our website and various social media platforms.

These trials have already uncovered some important lessons in their pilot phases, and we look forward to sharing them with you in the months to come! Visit our website often to learn more about our work and follow us on X for photos and updates from our research teams and partners.

HLB-SIMPLe is funded by the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute (NHLBI), a division of the US National Institutes of Health (NIH), through the following grants: U24-HL-154426, UH3-HL154499, UH3-HL-156390, UH3-HL-154498, UH3-HL-156388, UH3-HL-154501, UH3-HL156389.