Yale faculty members Drs. Donna Spiegelman, Raul U. Hernandez-Ramirez, Drew Cameron, and Jeremy Schwartz at Yale’s Center for Methods in Implementation and Prevention Science—along with Drs. Fred Semitala of Makerere University, Chris Longenecker of Case Western Reserve University, and others—were recently awarded a grant from the National Heart, Lung and Blood Institute for their project “Strengthening the Blood Pressure Care and Treatment Cascade for Ugandans Living with HIV - Implementation Strategies to SAve Lives” (PULESA-UGANDA).
In sub-Saharan Africa, hypertension is the most important driver of cardiovascular disease (CVD) risk, a well-established comorbidity among people living with HIV. Although HIV treatment in sub-Saharan Africa has greatly improved, hypertension care continues to face profound challenges. As Dr. Spiegelman explains the issue, “real people have multiple problems,” so the project is a “dream opportunity to address the adverse impacts of a siloed healthcare system.” PULESA-UGANDA proposes that HIV care be extended to include the prevention of non-AIDS comorbidity—in particular, hypertension—through equitable, cost-effective, and sustainable interventions.
The five-year implementation science study directly results from a decades-long collaboration between Ugandan and US institutions. Dr. Semitala, the Principal Investigator (PI), heads the Mulago clinic, the largest single HIV clinic in Uganda, and leads implementation studies in HIV/TB. Co-PI Dr. Longenecker’s research as a leading expert in CVD and HIV comorbidity involves a partnership with the Uganda Heart Institute. Dr. Spiegelman is contributing her expertise in implementation research methods in low- and middle-income countries, working with Dr. Hernandez-Ramirez on study design and monitoring and data analysis, and with Dr. Cameron on health economics. Dr. Schwartz is supporting the study team through his extensive collaborative research network in Uganda and experience studying non-communicable diseases.
This study aims to integrate evidence-based hypertension and HIV care by exploring current routines, barriers, and facilitators of hypertension care in HIV clinical settings in Uganda; determining the effectiveness of implementation strategies to improve hypertension cascade metrics with the study clinics; and evaluating the economic and financial sustainability of the integrated care strategies. In the future, the PULESA-UGANDA team envisions applying their methods and findings to other non-AIDS comorbidities to preserve the gains made in HIV care.