In:
PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 8 ( 2022-8-11), p. e0272727-
Abstract:
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. Methods 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. Results 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. Conclusions 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.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0272727
DOI:
10.1371/journal.pone.0272727.g001
DOI:
10.1371/journal.pone.0272727.g002
DOI:
10.1371/journal.pone.0272727.g003
DOI:
10.1371/journal.pone.0272727.t001
DOI:
10.1371/journal.pone.0272727.t002
DOI:
10.1371/journal.pone.0272727.s001
DOI:
10.1371/journal.pone.0272727.s002
DOI:
10.1371/journal.pone.0272727.s003
DOI:
10.1371/journal.pone.0272727.s004
DOI:
10.1371/journal.pone.0272727.s005
DOI:
10.1371/journal.pone.0272727.s006
DOI:
10.1371/journal.pone.0272727.s007
DOI:
10.1371/journal.pone.0272727.r001
DOI:
10.1371/journal.pone.0272727.r002
DOI:
10.1371/journal.pone.0272727.r003
DOI:
10.1371/journal.pone.0272727.r004
DOI:
10.1371/journal.pone.0272727.r005
DOI:
10.1371/journal.pone.0272727.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2267670-3
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