Ministry of Health and Social Services, Windhoek, Namibia.
Institute for Global Health Sciences, University of California, San Francisco, California, United States of America.
PLoS One. 2022 Aug 11;17(8):e0272727. doi: 10.1371/journal.pone.0272727. eCollection 2022.
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.
在纳米比亚，艾滋病毒感染者（PWH）中高血压（HTN）的患病率很高，但筛查和治疗高血压并未作为艾滋病毒护理的一部分常规提供。我们报告了实施质量改进合作（QIC）的情况，以加速在纳米比亚公立部门卫生机构中整合高血压和艾滋病毒护理。
24 家机构参与了 QIC，目的是增加成年 PWH（>15 岁）的高血压筛查和治疗。高血压根据国家治疗指南定义（即三次测量和至少两次的收缩压>140 和/或舒张压>90），仅由医生决定是否开始治疗。参与医院的团队使用质量改进方法、每月测量绩效指标和小规模的变革测试来实施针对具体情况的干预措施。临床官员每月对现场进行辅导，他们在 QI 和艾滋病毒方面具有专业知识，并召集现场作为学习会议的一部分，以促进有效干预措施的传播。
2017 年 3 月至 2018 年 3 月，参与机构的 183,043 次临床就诊中有 183,043 次（86%）进行了高血压筛查。在 1,759 名新诊断出高血压的 PWH 中，有 992 名（56%）开始接受一线治疗。有现场医生的机构（61%）比没有现场医生的机构（51%）的治疗开始率更高。在 QIC 期间，机构团队确定了 14 项改善高血压筛查和治疗的干预措施。在实施障碍方面，团队指出血压计故障和降压药物缺货是常见挑战。
在纳米比亚的 24 家高容量机构实施 QIC 为整合高血压和艾滋病毒服务提供了一种结构化方法。尽管设施层面的变化仍在继续，但高血压治疗率仍然很低，因此应采取政策层面的干预措施，如任务分担和供应链加强，以进一步提高艾滋病毒感染者的高血压护理水平，而不仅仅是初始筛查。
