Community-based Approaches to improve hypertension treatment among people living with HIV

BACKGROUND HIV/AIDS is a significant public health problem in sub-Saharan Africa (SSA), accounting for 70% of the global disease burden. Meanwhile, HIV mortality in SSA has declined due to expanded access to anti-retroviral therapy (ART). Some of the strategies that have contributed to this decline in SSA, apart from access to highly active anti-retroviral medications, are task sharing, which uses non-physician community healthcare workers (CHW). Leveraging such non-physician CHW support for the treatment of hypertension in persons living with HIV (PLHIV) is desirable, especially with the increasing burden of cardiovascular disease and their risk factors, especially hypertension in this population. And with the community-based approach for HIV treatment, the need to integrate non-communicable diseases (NCD) screening and management into such an approach cannot be over emphasized. OBJECTIVE We aimed to examine the context, facilitators, and barriers to implementing CHW support and home blood pressure (BP) monitoring in hypertensive PLHIV in HIV Clinics in Nigeria’s Federal Capital Territory (FCT) using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. METHODS We purposively sampled and conducted qualitative semi-structured key informant interviews with five each of hypertensive PLHIV, Community Health Extension Workers (CHEWs), Physicians, healthcare policymakers, Community Pharmacists, and Community nurses. Interviews were tape-recorded, transcribed, and coded based on themes identified. We analyzed data to describe the context, facilitators, and barriers to implementing CHW support and home BP monitoring in hypertensive PLHIV. RESULTS Contextual observations include existing donor-funded community ART refill mechanisms managed by volunteers. Proposed facilitators include providing policy framework, advocacy to stakeholders, government funding support, incentivizing volunteers and patients, identifying champions for home BP monitoring in hypertensive PLHIV, training, supportive supervision, and patient involvement. Barriers identified include financial constraints, non-existing policy framework, implementation guidelines, or dedicated human resources for home BP monitoring in hypertensive PLHIV, as well as provider, community, and patient resistance issues. CONCLUSION We identified facilitators and barriers for CHW support and home BP monitoring in hypertensive PLHIV, with existing donor-funded community ART refill mechanism being a major contextual factor.