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Integrating Hypertension and Cardiovascular Disease Care into Existing HIV Service Package in Botswana (InterCARE)

Award Number: UG3HL154499
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: COOPERATIVE AGREEMENT
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Integrating Hypertension and Cardiovascular Disease Care into Existing HIV Service Package in Botswana (InterCARE) - PROJECT SUMMARY An estimated 26% of people living with HIV (PLWHIV) in Botswana have hypertension. Uncontrolled hypertension will add to the already increased risk for cardiovascular (CVD) disease in this population. A hypertension study nested within an HIV prevention trial (Botswana Combination Prevention Project- BCPP), the hypertension continuum of care was suboptimal among PLWHIV; 46% aware of their hypertension, 42% on medication, 44% of those on medication at recommended blood pressure target, with an overall hypertension control of 19%. These data highlight multiple implementation gaps in our setting among PLWHIV for hypertension control and the missed opportunity to address CVD risk factors among those with hypertension. These gaps occur despite national guidelines recommendations, free universal healthcare, availability of needed medications and approaches which can improve quality including training, coaching, and the use of electronic health records (EHR) reminders. Implementation research is urgently needed to develop more effective strategies to improve the uptake of established effective hypertension and CVDRF management interventions among PLWHIV in Botswana and other low- and middle-income countries (LMICs). We propose the adaptation and testing of strategies to effectively integrate evidence- based interventions (EBI) into HIV care to improve hypertension cascade of care (awareness, diagnosis, treatment, control) and general CVD risk factor knowledge, diagnosis and treatment using a late-stage T4 implementation research hybrid type 2 study design. First, we will develop a set of implementation strategies for integrated HIV-HTN/CVD care within an existing HIV care platform for adults with HIV and hypertension and pilot test (2 HIV Clinics) to explore implementation outcomes using RE-AIM framework to inform adaptation for broader testing. We will use the knowledge gained from the development and piloting of the implementation strategy to then use a type 2 hybrid design to measure the implementation outcomes of multi-component strategy in improving EBI uptake and improvement success rates in the HTN cascade among adults with a dual diagnosis of HIV and Hypertension. To achieve this second aim, we are proposing a type 2 hybrid effectiveness-implementation of a 10-cluster randomized trial (1:1 randomization at the facility level) of 300 adults per cluster between 20- 75 years old with a dual diagnosis of HIV and hypertension (>140/90mmHg, >130/80mmHg if living with Diabetes mellitus/Chronic Kidney Disease) in Botswana. Our primary quantitative implementation outcomes based on the RE-AIM framework implementation are reach (proportion of PLWHIV on treatment among those who meet threshold for anti-hypertensive medication), effectiveness (proportion with controlled blood pressure), plus adoption (proportion of providers who screen PLWHIV for high blood pressure plus proportion of providers who prescribe anti-hypertensive medications). Our co-primary qualitative implementation outcomes will include assessment of fidelity (audit of intervention implementation as designed) and maintenance (provider and patient perceptions of ability to maintain plus change in blood pressure control from first control to end of the trial). Our secondary implementation outcomes, we will include assessment of feasibility (ability to implement integrated HIV/HTN care, HIV/HTN/CVD care, clinic viral suppression, etc.) and acceptability (patient and provider survey and interviews) of the implementation strategy.


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: 2025 ( Subtotal = $0 )
2025	2021	UNIVERSITY OF BOTSWANA	PLOT 4775 NOTWANE ROAD	GABORONE				BWA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	2	10/8/2024	NON-COMPETING CONTINUATION	$173,352
2025	2021	UNIVERSITY OF BOTSWANA	PLOT 4775 NOTWANE ROAD	GABORONE				BWA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	2	3/18/2025	NON-COMPETING CONTINUATION	-$173,352
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = -$173,352 )
2024	2021	UNIVERSITY OF BOTSWANA	PLOT 4775 NOTWANE ROAD	GABORONE				BWA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	2	9/9/2024	NON-COMPETING CONTINUATION	$0
2024	2021	UNIVERSITY OF BOTSWANA	PLOT 4775 NOTWANE ROAD	GABORONE				BWA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	2	9/23/2024	NON-COMPETING CONTINUATION	-$173,352
														Subtotal = -$173,352

Issue Date FY: 2023 ( Subtotal = -$128,078 )
2023	2021	UNIVERSITY OF BOTSWANA	PLOT 4775 NOTWANE ROAD	GABORONE				BWA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	2	6/20/2023	NON-COMPETING CONTINUATION	-$249
2023	2021	UNIVERSITY OF BOTSWANA	PLOT 4775 NOTWANE ROAD	GABORONE				BWA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	2	6/20/2023	NON-COMPETING CONTINUATION	-$127,830
														Subtotal = -$128,078

Issue Date FY: 2021 ( Subtotal = $670,009 )
2021	2021	UNIVERSITY OF BOTSWANA	PLOT 4775 NOTWANE ROAD	GABORONE				BWA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	2	8/24/2021	NON-COMPETING CONTINUATION	$670,009
2021	2020	UNIVERSITY OF BOTSWANA	PLOT 4775 NOTWANE ROAD	GABORONE				BWA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	1	8/16/2021	NEW	$0
														Subtotal = $670,009

Issue Date FY: 2020 ( Subtotal = $686,364 )
2020	2020	UNIVERSITY OF BOTSWANA	NOTWANE ROAD	GABORONE				BWA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	1	9/17/2020	NEW	$0
2020	2020	UNIVERSITY OF BOTSWANA	NOTWANE ROAD	GABORONE				BWA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	1	9/11/2020	NEW	$686,364
														Subtotal = $686,364

Grand Total All Awards = $1,054,942

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Integrating Hypertension and Cardiovascular Disease Care into Existing HIV Service Package in Botswana (InterCARE)

Award Number: UG3HL154499

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: COOPERATIVE AGREEMENT

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

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