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PULESA-UGANDA-Strengthening the Blood Pressure Care and Treatment cascade for Ugandans living with HIV-ImpLEmentation Strategies to SAve lives

Award Number: UG3HL154501
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: COOPERATIVE AGREEMENT
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/10/2020
PERIOD OF PERFORMANCE END DATE: 08/31/2022

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PULESA-UGANDA-Strengthening the Blood Pressure Care and Treatment cascade for Ugandans living with HIV-ImpLEmentation Strategies to SAve lives - Project Summary Chronic HIV infection is a well-established risk factor for cardiovascular disease. In sub-Saharan Africa)—a region that may account for half of the global burden of CVD attributable to HIV—hypertension is the most important driver of CVD risk. Profound barriers to effective hypertension management exist, including limited knowledge, inconsistent BP measurement, and poor access to medications. HIV care innovations such as access to no-cost antiretroviral therapy, differentiated service delivery and use of PLHIV peers in care models may improve care of comorbid conditions such as hypertension. The overarching goal of PULESA-UGANDA study is to improve the BP treatment cascade for people living with HIV (PLHIV) in urban and peri-urban Uganda in a scalable and sustainable manner. This hybrid IS Type 3 study proposes to first explore current practice, routines, barriers, and facilitators of evidence–based BP care in HIV clinical settings in Kampala and Wakiso districts (Aim 1). Then, using a human-centered design approach, a design team of key stakeholders will use data from the formative assessment to develop a multi-component implementation strategy (HTN-PLUS) to improve uptake and adherence to evidence-based BP treatments, contextually adapted to these Ugandan HIV clinics (Sub-aim 1.1). The design team will adapt differentiated service delivery models, use of hypertensive PLHIV peer champions, and methods of BP monitoring that address specific barriers and facilitators of BP care. In a stepped-wedge cluster randomized trial of 16 clinics from Kampala and Wakiso, we will determine the effectiveness of implementation strategies to improve BP cascade metrics (Aim 2). Clinics will be randomized to receive free and consistent access to diagnostic equipment and evidence-based antihypertensive drugs (HTN-BASIC) with and without the multi-component implementation strategy developed in sub-aim 1 (HTN-PLUS). The primary effectiveness outcome will be % of patients with hypertension diagnosis who are controlled (<140mmHg systolic). We hypothesize that the HTN-BASIC intervention will increase control from 25% at baseline to 35%, and that HTN-PLUS will further increase control to 40%. We will conduct an extensive mixed-methods process evaluation. We will assess scalability as our main implementation outcome, and will also assess acceptability, adoption, and implementation climate. Finally, we will evaluate the economic and financial sustainability of the integrated care strategies in a cost-effectiveness analysis from a societal perspective that will include household out-of-pocket expenditures. The primary outcome of this aim will be incremental cost per BP- controlled patient. This study will provide much needed evidence to SSA government stakeholders for a strategy to preserve the health gains of HIV treatment by preventing death and disability from CVD. Importantly, it will offer economic evidence of the scalability, sustainability, and equity of a model of HIV- hypertension management integration.


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: 2024 ( Subtotal = -$381,662 )
2024	2021	INFECTIOUS DISEASES RESEARCH COLLABORATION	PLOT 2C NAKASERO HILL ROAD	KAMPALA				UGA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	2	11/9/2023	NON-COMPETING CONTINUATION	-$381,662
														Subtotal = -$381,662

Issue Date FY: 2021 ( Subtotal = $745,496 )
2021	2021	INFECTIOUS DISEASES RESEARCH COLLABORATION	PLOT 2C NAKASERO HILL ROAD	KAMPALA				UGA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	003	2	9/9/2021	NON-COMPETING CONTINUATION	$745,496
2021	2020	INFECTIOUS DISEASES RESEARCH COLLABORATION	PLOT 2C NAKASERO HILL ROAD	KAMPALA				UGA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	002	1	5/28/2021	NEW	$0
2021	2020	INFECTIOUS DISEASES RESEARCH COLLABORATION	PLOT 2C NAKASERO HILL ROAD	KAMPALA				UGA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	1	10/30/2020	NEW	$740,559
2021	2020	INFECTIOUS DISEASES RESEARCH COLLABORATION	PLOT 2C NAKASERO HILL ROAD	KAMPALA				UGA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	1	10/28/2020	NEW	-$740,559
														Subtotal = $745,496

Issue Date FY: 2020 ( Subtotal = $740,559 )
2020	2020	INFECTIOUS DISEASES RESEARCH COLLABORATION	PLOT 2C NAKASERO HILL ROAD	KAMPALA				UGA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	1	9/8/2020	NEW	$740,559
2020	2020	INFECTIOUS DISEASES RESEARCH COLLABORATION	PLOT 2C NAKASERO HILL ROAD	KAMPALA				UGA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	1	9/17/2020	NEW	$0
														Subtotal = $740,559

Grand Total All Awards = $1,104,393

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PULESA-UGANDA-Strengthening the Blood Pressure Care and Treatment cascade for Ugandans living with HIV-ImpLEmentation Strategies to SAve lives

Award Number: UG3HL154501

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: COOPERATIVE AGREEMENT

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

PERIOD OF PERFORMANCE START DATE: 09/10/2020

PERIOD OF PERFORMANCE END DATE: 08/31/2022

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