Journal of the International AIDS Society
Authors: Angela Aifah, Emmanuel K. Tetteh, Karla I. Galaviz, Michael E. Herce, Norberto Lumbandali, Martin Muddu, Lisa R. Hirschhorn
In this study, the authors examined implementation strategies used to integrate cardiovascular disease (CVD) care into routine HIV services across six African countries: Botswana, Mozambique, Nigeria, South Africa, Uganda, and Zambia. The study addressed the growing burden of hypertension and diabetes among people living with HIV (PWH) and the need to incorporate chronic disease prevention and management into existing HIV care platforms. Researchers reviewed clinical trial protocols and consulted study teams between December 2022 and September 2023. Guided by the Expert Recommendations for Implementing Change (ERIC) taxonomy, they identified and compared strategies targeting healthcare workers, patients, healthcare facilities, and health systems.
The analysis identified ten implementation strategies across six trials evaluating hypertension care and one trial also addressing diabetes care. Three strategies were common to all six trials: healthcare worker training, audit and feedback, and practice facilitation or coaching. Although these approaches shared the goal of strengthening provider capacity and improving care quality, their implementation varied according to local resources and health system infrastructure. Training differed in duration, frequency, and trainer type, while audit and feedback processes varied in data utilization and integration with district-level quality improvement systems. Practice facilitation ranged from study-led to health system-led approaches.
Overall, the findings highlighted the importance of adapting implementation strategies to local contexts while maintaining core intervention functions. The authors emphasized that successful HIV-CVD service integration requires more than healthcare worker training alone. Coaching, practice facilitation, and strengthened data systems may be essential for sustainable integration of hypertension and diabetes management into routine HIV care across resource-limited settings in Africa.