Johnson Leslie C M, Khan Suha H, Ali Mohammed K, Galaviz Karla I, Waseem Fatima, Ordóñez Claudia E, Siedner Mark J, Nyatela Athini, Marconi Vincent C, Lalla-Edward Samanta T
Department of Family and Preventive Medicine, School of Medicine, Emory University, 1518 Clifton Rd, 30322, Atlanta, GA, USA.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, 30322, Atlanta, GA, USA.
Implement Sci Commun. 2024 Aug 1;5(1):87. doi: 10.1186/s43058-024-00625-5.
The burden of hypertension among people with HIV is high, particularly in low-and middle-income countries, yet gaps in hypertension screening and care in these settings persist. This study aimed to identify facilitators of and barriers to hypertension screening, treatment, and management among people with HIV in primary care clinics in Johannesburg, South Africa. Additionally, different stakeholder groups were included to identify discordant perceptions.
Using a cross-sectional study design, data were collected via interviews (n = 53) with people with HIV and hypertension and clinic managers and focus group discussions (n = 9) with clinic staff. A qualitative framework analysis approach guided by COM-B and the Theoretical Domains Framework were used to identify and compare determinants of hypertension care across stakeholder groups.
Data from clinic staff and managers generated three themes characterizing facilitators of and barriers to the adoption and implementation of hypertension screening and treatment: 1) clinics have limited structural and operational capacity to support the implementation of integrated care models, 2) education and training on chronic care guidelines is inconsistent and often lacking across clinics, and 3) clinicians have the goal of enhancing chronic care within their clinics but first need to advocate for health system characteristics that will sustainably support integrated care. Patient data generated three themes characterizing existing facilitators of and barriers to clinic attendance and chronic disease self-management: 1) the threat of hypertension-related morbidity and mortality as a motivator for lifestyle change, 2) the emotional toll of clinic's logistical, staff, and resource challenges, and 3) hypertension self-management as a patchwork of informational and support sources. The main barriers to hypertension screening, treatment, and management were related to environmental resources and context (i.e., lack of enabling resources and siloed flow of clinic operations) and patients' knowledge and emotions (i.e., lack of awareness about hypertension risk, fear, and frustration). Clinical actors and patients differed in perceived need to prioritize HIV versus hypertension care.
The convergence of multi-stakeholder data highlight key areas for improvement, where tailored implementation strategies targeting motivations of clinic staff and capacity of patients may address challenges to hypertension screening, treatment, and management recognized across groups.
艾滋病毒感染者中的高血压负担很高，尤其是在低收入和中等收入国家，但这些地区在高血压筛查和护理方面的差距依然存在。本研究旨在确定南非约翰内斯堡初级保健诊所中艾滋病毒感染者高血压筛查、治疗和管理的促进因素和障碍。此外，纳入了不同的利益相关者群体以识别不一致的看法。
采用横断面研究设计，通过对艾滋病毒合并高血压患者及诊所管理人员进行访谈（n = 53）以及与诊所工作人员进行焦点小组讨论（n = 9）来收集数据。采用以COM-B和理论领域框架为指导的定性框架分析方法，以识别和比较各利益相关者群体中高血压护理的决定因素。
来自诊所工作人员和管理人员的数据产生了三个主题，这些主题表征了高血压筛查和治疗采用与实施的促进因素和障碍：1）诊所支持综合护理模式实施的结构和运营能力有限；2）各诊所之间关于慢性病指南的教育和培训不一致且常常缺乏；3）临床医生的目标是在其诊所内加强慢性病护理，但首先需要倡导有利于可持续支持综合护理的卫生系统特征。患者数据产生了三个主题，这些主题表征了就诊和慢性病自我管理的现有促进因素和障碍：1）高血压相关发病和死亡的威胁成为生活方式改变的动力；2）诊所后勤、工作人员和资源挑战带来的情感负担；3）高血压自我管理是信息和支持来源的拼凑。高血压筛查、治疗和管理的主要障碍与环境资源和背景（即缺乏有利资源和诊所运营的条块分割流程）以及患者的知识和情绪（即对高血压风险缺乏认识、恐惧和沮丧）有关。临床工作人员和患者在认为应优先考虑艾滋病毒护理还是高血压护理方面存在差异。
多利益相关者数据的趋同突出了需要改进的关键领域，针对诊所工作人员动机和患者能力的量身定制的实施策略可能会应对各群体公认的高血压筛查、治疗和管理方面的挑战。
