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

• 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
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0272727

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.