Integrating hypertension and HIV care in Namibia: A quality improvement collaborative approach

Hypertension (HTN) is highly prevalent among people with HIV (PWH) in Namibia, but screening and treatment for HTN are not routinely offered as part of HIV care delivery. We report the implementation of a quality improvement collaborative (QIC) to accelerate integration of HTN and HIV care within pu...

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Bibliographic Details
Published in:	PloS one Vol. 17; no. 8; p. e0272727
Main Authors:	Basenero, Apollo, Neidel, Julie, Ikeda, Daniel J, Ashivudhi, Hilaria, Mpariwa, Simbarashe, Kamangu, Jacques W. N, Mpalang Kakubu, Mireille A, Hans, Linea, Mutandi, Gram, Jed, Suzanne, Tjituka, Francina, Hamunime, Ndapewa, Agins, Bruce D
Format:	Journal Article
Language:	English
Published:	San Francisco Public Library of Science 11-08-2022 Public Library of Science (PLoS)
Subjects:	Antihypertensives Biology and Life Sciences Blood pressure Cardiovascular disease Care and treatment Coaching Collaboration Complications and side effects Health care delivery Health care facilities Health services Highly active antiretroviral therapy HIV HIV (Viruses) Hospital facilities Human immunodeficiency virus Hypertension Integrated delivery systems Malfunctions Medicine and Health Sciences Meetings Mortality Nurses Patient outcomes People and Places Physicians Quality control Quality improvement Screening Supply chains Teams Namibia
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Summary:	Hypertension (HTN) is highly prevalent among people with HIV (PWH) in Namibia, but screening and treatment for HTN are not routinely offered as part of HIV care delivery. We report the implementation of a quality improvement collaborative (QIC) to accelerate integration of HTN and HIV care within public-sector health facilities in Namibia. Twenty-four facilities participated in the QIC with the aim of increasing HTN screening and treatment among adult PWH (>15 years). HTN was defined according to national treatment guidelines (i.e., systolic blood pressure >140 and/or diastolic blood pressure >90 across three measurements and at least two occasions), and decisions regarding initiation of treatment were made by physicians only. Teams from participating hospitals used quality improvement methods, monthly measurement of performance indicators, and small-scale tests of change to implement contextually tailored interventions. Coaching of sites was performed on a monthly basis by clinical officers with expertise in QI and HIV, and sites were convened as part of learning sessions to facilitate diffusion of effective interventions. Between March 2017 and March 2018, hypertension screening occurred as part of 183,043 (86%) clinical encounters at participating facilities. Among 1,759 PWH newly diagnosed with HTN, 992 (56%) were initiated on first-line treatment. Rates of treatment initiation were higher in facilities with an on-site physician (61%) compared to those without one (51%). During the QIC, facility teams identified fourteen interventions to improve HTN screening and treatment. Among barriers to implementation, teams pointed to malfunctions of blood pressure machines and stock outs of antihypertensive medications as common challenges. Implementation of a QIC provided a structured approach for integrating HTN and HIV services across 24 high-volume facilities in Namibia. As rates of HTN treatment remained low despite ongoing facility-level changes, policy-level interventions-such as task sharing and supply chain strengthening-should be pursued to further improve delivery of HTN care among PWH beyond initial screening.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0272727