PROJECT SUMMARY
This project focuses on task shifting and integrating the evidence-based WHO Package of Essential
Noncommunicable Disease Interventions (WHO-PEN) approach to managing cardiovascular disease risk
factors and cardiometabolic complication of HIV into routine care settings for persons living with HIV in
Lusaka, Zambia. Using local data and implementation science theories, we will adapt WHO-PEN for the
national HIV program in Zambia, and create a streamlined, task-shifted evidence-based intervention that
we have coined “TASKPEN”. TASKPEN will focus on addressing challenges faced by HIV patients who
have cardio-metabolic complications related to HIV or its treatment, but in the future could be expanded to
address other noncommunicable diseases. TASKPEN aims to improve detection and management of these
complications. We hypothesize that the TASKPEN intervention will result in reduced cardiovascular disease
risk as determined by the Data-collection on Adverse Effects of Anti-HIV Drugs (D:A:D) risk score, as well
as clinical improvement in a number of secondary end-points, including HIV viral suppression, for HIV-
positive patients attending PEPFAR-supported HIV clinics in the urban Lusaka district of Zambia. The
implementation strategies used will enable productive interactions between activated, informed patients
and proactive, prepared health care professionals by task shifting most of the care to nurses and
community health workers who will be supported by the training and adapted screening and treatment
algorithms based on WHO-PEN protocols. TASKPEN will be integrated into routine primary care HIV
services where nurses and community health workers lead the intervention. As the individual components
of TASKPEN are already recommended by Zambia national HIV guidelines, screening of participants to
take part in the study will be done as part of routine HIV care. For those eligible, the screening for metabolic
complications will be done at baseline, and 6, 12, and 24 months. Those found with any cardiometabolic
complications will receive an individualized management plan, which will combine usual HIV care plus the
adapted protocol for management of cardiovascular disease risk factors and cardiometabolic complications.
To advocate for scale-up of TASKPEN in Zambia, we plan to evaluate its clinical impact using a cross-
sectional type 2-hybrid effectiveness-implementation stepped-wedge design, which is a quasi-experimental
design that allows for measurement of clinical effectiveness alongside assessment of implementation
outcomes and strategies. Our hope is that by the end of the study, the Zambian Ministry of Health will
maintain TASKPEN at all study facilities and would consider wider scale-up in the Zambian health system.
