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Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SAIA-HTN)

Award Number: R01HL142412
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Undiagnosed and untreated hypertension (HTN) is one of the largest drivers of cardiovascular disease (CVD) in sub-Saharan Africa (sSA). Across sSA, evidence-based, clinical guidelines to screen and manage hypertension exist; however, country level application is low and uneven due to lack of service readiness, uneven health worker motivation, lack of accountability for health worker performance and poor integration of HTN screening and management with chronic care services. In Mozambique – like many countries with high HIV burden – the HIV treatment platform was the first broadly implemented chronic care service. With large numbers of patients on anti-retroviral treatment (850,000 in Mozambique), it presents a unique opportunity to standardize and scale hypertension screening and management. Low-cost, systems level interventions are effective and efficient approaches to improve linked cascade services, and may be effective for routinizing HTN diagnosis and management within existing chronic care services; addressing both individual and systems-level barriers; improving flow through the HTN cascade; and ultimately improving patient level outcomes. The Systems Analysis and Improvement Approach (SAIA) is designed to optimize cascade performance, is feasible for frontline healthcare workers and managers, and is applicable to optimize the HTN testing and treatment cascade for people living with HIV (PLHIV) across multiple contexts. We have successfully piloted SAIA for the HTN cascade for PLHIV, and as HTN screening and management is mainstreamed into chronic care services in sSA (including in Mozambique), demonstrating SAIA-HTN potential effectiveness as an adaptable, scalable model for broad implementation. The overall goal of SAIA-HTN is to evaluate a model for systematic assessment and improvement of HTN diagnosis and management services for PLHIV in Mozambique. Our specific aims are to: (1) Determine the effectiveness of SAIA-HTN on HTN cascade optimization for HIV-infected individuals; (2) Determine the drivers of SAIA-HTN intervention implementation heterogeneity across facilities; (3) Determine the costs and cost-effectiveness of SAIA-HTN for care cascade optimization. We will deploy a cluster randomized trial to evaluate the impact of the SAIA-HTN intervention on hypertension management in 8 intervention and 8 control facilities. Effectiveness will be measured via HTN cascade flow measures for PLHIV and HTN and HIV clinical outcomes. Intervention costs will be assessed from the payer perspective (e.g. MOH), and cost effectiveness analysis conducted to estimate the incremental costs for additional patients passing through the HTN cascade steps, and the cost per additional disability-adjusted life year averted (DALY). The implementation process will be described using focus group discussions and key informant interviews analyzed using the Consolidated Framework for Implementation Research, with complementary data from study logs to describe fidelity to the SAIA-HTN intervention design.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = $683,650 )
2023	2023	UNIVERSITY OF WASHINGTON	4333 BROOKLYN AVE NE	SEATTLE	WA	98195	KING	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	5	4/7/2023	NON-COMPETING CONTINUATION	$683,650
														Subtotal = $683,650

Issue Date FY: 2022 ( Subtotal = $676,773 )
2022	2022	UNIVERSITY OF WASHINGTON	4333 BROOKLYN AVE NE	SEATTLE	WA	98195	KING	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	4	5/3/2022	NON-COMPETING CONTINUATION	$676,773
														Subtotal = $676,773

Issue Date FY: 2021 ( Subtotal = $668,567 )
2021	2021	UNIVERSITY OF WASHINGTON	4333 BROOKLYN AVE NE	SEATTLE	WA	98195	KING	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	3	4/14/2021	NON-COMPETING CONTINUATION	$668,567
														Subtotal = $668,567

Issue Date FY: 2020 ( Subtotal = $670,946 )
2020	2020	UNIVERSITY OF WASHINGTON	4333 BROOKLYN AVE NE	SEATTLE	WA	98195	KING	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	2	4/30/2020	NON-COMPETING CONTINUATION	$670,946
														Subtotal = $670,946

Issue Date FY: 2019 ( Subtotal = $675,730 )
2019	2019	UNIVERSITY OF WASHINGTON	4333 BROOKLYN AVE NE	SEATTLE	WA	98195	KING	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	1	5/1/2019	NEW	$675,730
														Subtotal = $675,730

Grand Total All Awards = $3,375,666

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Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SAIA-HTN)

Award Number: R01HL142412

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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