Practice facilitation for integrating hypertension management into HIV care led to a 2.7 mmHg greater reduction in systolic blood pressure compared to self-directed care (95% CI -4.53 to -0.85; P=0.004).
RCT (n=954)
stepped-wedge cluster
Yes
Does practice facilitation added to a task-strengthening strategy improve systolic blood pressure reduction and BP control in people living with HIV with uncontrolled hypertension?
Using practice facilitation as an implementation strategy to integrate hypertension management into HIV care significantly reduced systolic blood pressure compared to self-directed care.
Mean Difference: -2.7 (95% CI -4.53–-0.85)
p-value: p=0.004
Objective: To test the comparative effectiveness of practice facilitation (PF) versus self-directed care (SDC) as two implementation strategies for integrating Task-Strengthening Strategy for Hypertension control (TASSH), into HIV chronic care platform across 30 primary healthcare centers (PHCs) in Nigeria.Design and method: It was a stepped-wedge cluster randomised trial. Thirty (30) public primary healthcare centres (PHCs) in Nigeria were randomly allocated into 5 sequences (of 6 PHCs) that varied the initiation of practice facilitation (PF), each beginning with self-directed care (SDC) which is TASSH alone, followed by the intervention (TASSH plus PF). TASSH which is an adaptation of World Health Organisation HEARTS Technical Package includes lifestyle counselling, referral of complicated hypertension and community nurses initiating antihypertensive treatment for uncomplicated cases with either 5 mg of Amlodipine or single pill combination (SPC) of Amlodipine (5 mg) + Losartan (50 mg) depending on screening blood pressure (BP) levels, and escalating as need arises to SPC of amlodipine (10 mg) plus losartan (100 mg) and finally SPC of amlodipine (10 mg) plus losartan (100 mg) plus hydrochlorothiazide(25 mg). The clinical effectiveness outcome includes the difference in systolic blood pressure (SBP) reduction and BP control, between SDC and 12 months of practice facilitation. Results: A total of 954 PLWH with uncontrolled hypertension (71% women, mean age 49.2 (SD:10.8), mean baseline BP: 152.6(10.5)/92.1(8.3) mmHg) were enrolled from October 2022 to March 2023 and followed through October 2025. BP control (<140/90mmHg) improved by 5% (95% CI: -0.003, 0.11, P= 0.06) between the SDC and intervention periods 85.3% (81.0, 89.7) versus 90.6% (85.0, 96.1). PF led to 2.7 mmHg (95% CI: -4.53, -0.85, P=0.004) reduction in SBP compared to SDC, and SBP reduced from 152.6mmHg (95% CI:152.0, 153.3) at screening (baseline) to 123.5mmHg (95% CI:122.8, 124.1) after 12 months of PF intervention. The Frequency distributions of BP in 1mmHg categories from screening to 12-month of TASSH plus PF (Figure) further illustrates these findings. Conclusions: Integration of TASSH in 30 public primary healthcare facilities in Nigeria with PF as an implementation strategy led to significant BP reduction and improved BP control, with control rate of over 90% after 12 months of intervention
Ojji et al. (Fri,) conducted a rct in Uncontrolled hypertension in people living with HIV (n=954). Task-Strengthening Strategy for Hypertension control (TASSH) plus practice facilitation (PF) vs. Self-directed care (TASSH alone) was evaluated on Systolic blood pressure (SBP) reduction (MD -2.7 mmHg, 95% CI -4.53 to -0.85, p=0.004). Practice facilitation for integrating hypertension management into HIV care led to a 2.7 mmHg greater reduction in systolic blood pressure compared to self-directed care (95% CI -4.53 to -0.85; P=0.004).
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