Models for Integrated HIV-Hypertension Care: Comparative Analysis of Six Integration Approaches from Implementation Research Projects Across Africa

Abstract Introduction: In 2020, the National Heart, Lung and Blood Institute formed the Heart, Lung, and Blood Co-morbiditieS IMplementation Models in People Living with HIV (HLB SIMPLe) Alliance, funding implementation research projects in six countries in Africa including Botswana, Mozambique, Nigeria, South Africa, Uganda and Zambia to test diverse models for integrating hypertension services into routine HIV care. We describe key similarities and differences amongst the integration models. Methods: This sequential explanatory mixed-methods study used online structured questionnaires and meetings to gather quantitative and qualitative data from each project. Integration was defined as the delivery of HIV and hypertension care concurrently for people living with HIV, specifically across the WHO health system building blocks: service delivery (care delivered at the same time/same location), health workforce (same team of healthcare providers), health information systems (merging of information systems), access to essential medicines (medications for both HIV and hypertension in the same pharmacy), and health financing (integrated funding). Data were analyzed using descriptive statistics and rapid deductive content analysis. We then used this data together with the WHO Health System Building Blocks framework to describe HIV-hypertension integration models across key aspects of the health system. Results: All models fully integrated service delivery and health workforce, often using task sharing to address workforce shortages. Full integration of health information systems was observed in 5/6 projects, and integrated access to essential medication in all projects. Integration occurred at the primary healthcare level and excluded complicated hypertension cases. Only 2/6 projects had integrated health financing for HIV/hypertension care. Conclusions : This examination highlights high convergence in the design of HIV and hypertension care integration models across WHO Health System Building Blocks despite different study settings, with the main difference being divergent mechanisms of health financing for integrated HIV/hypertension care. Lessons learned will help develop a core set of guidelines for building country-specific models for integrating hypertension and HIV care across different African settings. Trial Registration: NCT05414526 / NCT05002322 / NCT05031819 / NCT05846503 / NCT05609513 / NCT05005130 / NCT05950919 Clinical Trial Numbers : NCT05414526 (1/31/2023-8/31/2025) (Botswana), NCT05002322 (2/13/2023-12/31/2025) (Mozambique), NCT05031819 (10/26/2022-4/30/2025) (Nigeria), NCT05846503 (6/1/2023-5/31/2025) (South Africa), NCT05609513 (02/06/2023-10/3/2025) (Uganda), NCT05005130 (9/20/2021-12/23/2022); NCT05950919 (05/30/2023-12/01/2025) (Zambia)