John Baptist Kiggundu (PULESA), Lisa de las Fuentas (RCC), Fred Semitala (PULESA), Adam Wilcox (RCC), Kenneth Schechtman (RCC), Angela Brown (RCC), and Victor Davila-Roman pose for a photo outside the IDRC office in Kampala, Uganda in April 2024. (PHOTO: RCC/Washington University in St. Louis).
The HLB-SIMPLe Research Coordinating Center (RCC), led by Washington University in St. Louis researchers, coordinates activities and provides organizational, administrative, technical, and communications support to alliance researchers and their teams. To this end, RCC representatives visit each of the six HLB-SIMPLe research projects annually to meet with study team members in-person and to get updates on their progress. In April 2024, Drs. Victor Davila-Roman, Ken Schechtman, Mark Huffman, Lisa de las Fuentes, Angela Brown, and Adam Wilcox, went to visit the PULESA Uganda and MAP-IT Nigeria projects.
PULESA Uganda
During time in Kampala, RCC investigators visited two clinics.
The Komamboga Health Clinic serves 555 people living with HIV (PLHIV) who also have hypertension. It sees 80-100 patients per day and provides services to treat/manage diseases, including hypertension and HIV, as well as maternity care. The study team heard from an 82-year-old project participant who told them that his engagement with PULESA saved him time and money, making it easier and more convenient to manage his hypertension, and that his once extremely high blood pressure is now controlled.
The Kawanda Health Clinic is a smaller clinic that sees 20-30 patients per day. Clinic staff said that the PULESA intervention is providing substantial benefits to study participants as they can now receive personalized hypertension management care close to home.
Staff from the Kawanda Health Clinic III in Kampala, Uganda in April 2024. (PHOTO: RCC/Washington University in St. Louis).
The RCC team also had several discussions with the study team and project stakeholders during their visit.
Key discussion highlights
- Project progress update: Dr. Fred Semitala, lead investigator of PULESA from Makerere University, reported on the trial’s progress, highlighting impressive enrollment numbers that exceed the initial target, and the inclusion of a longitudinal cohort sub-study.
- Discussion of integration challenges: Dr. Nakawuka Mina of the Uganda Ministry of Health presented data on HIV in Uganda and the integration of screening and management of non-communicable diseases (NCDs) into HIV services. Challenges associated with NCD management include inadequate treatment options, a lack of standardized management procedures, gaps in the training of health care workers, and inadequate standard operating procedures and guidelines. Current estimates suggest that diabetes and hypertension screening in HIV clinics exceeds 50% whereas screening for depression and substance abuse is at 20% or lower. Remaining challenges include the need for improved documentation of NCD screening activities, non-standard management of NCDs among PLHIV, limited human resources, and a slow roll out of guidelines for NCD management.
- Learn As You Go (LAGO) methodology description: Professor Donna Spiegelman of Yale University, lead statistician for PULESA, described the LAGO approach the project is using to guide intervention modifications based on interim data to maximize effectiveness.
- Community engagement: The RCC’s Dr. Angela Brown led a discussion on community engagement that produced several general themes. Patient participants, clinicians, and health ministry representatives recognized that building on the strengths and resources of the local community is central to sustainability of the integrated care approach. Patients and staff expressed the importance of utilizing community health workers, patients, religious leaders, and local clinic workers as trusted sources for getting information to the study participants and the general community.
MAP-IT Nigeria
The RCC team made their way to Abuja, Nigeria, where they met with the MAP-IT study team before heading to Uyo, Akwa Ibom to tour two study facilities (a high-volume clinic and a lower-volume clinic) for glimpses into their HIV care workflows and hypertension management protocols.
Representatives from the MAP-IT study team pose for a photo with representatives from the RCC at the Larai Restaurant in Abuja, Nigeria in April 2024. (PHOTO: RCC/Washington University in St. Louis).
The Ifa Atai Primary Health Care Post is currently serving 131 HIV clients and staffed by a community nurse and three other health care workers. Staff routinely measures clients blood pressure during their visits for HIV care. Hypertension prevalence is 21%, and blood pressure is being managed by standard protocol.
The Uyo Primary Health Care Center currently serves over 2,000 HIV patients, 13% of them have hypertension. Nurses at the facility explained that all HIV patients have their blood pressure measured during clinic visits but also during community activities and/or at home.
Dr. Angela Brown (RCC) and Dr. Angela Aifah (MAP-IT). (PHOTO: RCC/Washington University in St. Louis).
The RCC representatives had many important conversations while in Akwa Ibom.
Key discussion highlights
- Stakeholder meeting: More than 40 people from multiple sectors, including government, civil society, and academia joined a conversation with MAP-IT and RCC investigators to discuss expanding insurance and healthcare coverage, reducing HIV stigma, and integrating MAP-IT curriculum into nursing programs in Nigeria.
- Community Advisory Board consultation: Dr. Angela Brown led discussions with community stakeholders, fostering connections and addressing concerns related to project sustainability and healthcare access.
- Data harmonization and capacity building: Data standardization and capacity building efforts were discussed to enhance research outcomes and support future collaborations.
Both site visits underscored the significance of community engagement, interdisciplinary collaboration, and sustainability planning in global health research and program implementation. Recommendations included expanding awareness campaigns, strengthening primary healthcare capacity, and advocating for continued support beyond project timelines.
By fostering partnerships, leveraging data-driven approaches, and prioritizing community needs, these initiatives offer promising pathways towards healthier futures for vulnerable populations worldwide.
HLB-SIMPLe is funded by the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute (NHLBI) and the Fogarty International Center at the US National Institutes of Health (NIH). The MAP-IT Nigeria grant is UH3-HL-154498, PULESA Uganda’s is UH3-HL-154501 and the RCC grant is U24-HL-154426.