Pre-implementation Process Mapping to inform the Design of a Multicomponent Hypertension Screening Intervention Integrated into HIV Differentiated Service Delivery at Community Pharmacies in Kampala, Uganda

Background The scale-up of antiretroviral therapy has substantially improved life expectancy among people living with HIV, while concurrently increasing the risk of hypertension and other non-communicable diseases (NCDs). In Uganda, differentiated service delivery (DSD) models increasingly use community pharmacies for ART refills; however, these models of care lack systematic screening for NCDs. We applied pre-implementation process mapping to identify workflow gaps, implementation opportunities, and required adaptations to integrate blood pressure screening into pharmacy-based HIV differentiated service delivery. Methods We conducted a pre-implementation process-mapping study at the Mulago Immune Suppression Syndrome (ISS) Clinic and two affiliated community pharmacies in Kampala between June and July 2024. Guided by the PRECEDE framework and Lean Six Sigma principles, we integrated data from 12 key-informant interviews with clinic and pharmacy staff and eight structured workflow observation sessions. Preliminary process maps were iteratively refined and validated through stakeholder consultations to produce a consolidated workflow map to inform integration of BP screening into pharmacy-based HIV differentiated service delivery. Results Across sites, eight preliminary process maps demonstrated highly consistent ART refill workflows. The final consolidated map identified feasible integration points for BP screening, most notably during the waiting and counselling stages, without disrupting service flow. Stakeholders broadly endorsed integration but emphasised the need for staff training, validated BP equipment, and standardised referral protocols. Patients valued the convenience of combined HIV–NCD services, although concerns about additional costs and potential increase in waiting times were raised. System-level gaps, such as informal referral pathways and weak documentation practices, were identified as potential threats to effective follow-up for clients with elevated BP Conclusions Pre-implementation process mapping demonstrated that integrating BP screening into pharmacy-based DSD HIV care is feasible and acceptable, with minimal disruptions to existing ART refill workflows. The findings highlight specific workflow integration points and system requirements, including staff capacity building, validated equipment and standardised referral and documentation. Strengthening these elements could enable community pharmacies to serve as effective platforms for integrated HIV–NCD care in urban Uganda.