Capabilities, opportunities and motivations for integrating evidence-based strategy for hypertension control into HIV clinics in Southwest Nigeria

Abstract

Background Given the growing burden of cardiovascular diseases in sub-Saharan Africa, global donors and governments are exploring strategies for integrating evidence-based cardiovascular diseases prevention into HIV clinics. We assessed the capabilities, motivations and opportunities that exist for HIV clinics to apply evidence-based strategies for hypertension control among people living with HIV (PLHIV) in Nigeria. Methods We used a concurrent Quan-Qual- study approach (a quantitative first step using structured questionnaires followed by a qualitative approach using stakeholder meetings).We invited key stakeholders and representatives of HIV and non-communicable disease organizations in Lagos, Nigeria to 1) assess the capacity of HIV clinics (n = 29) to, and; 2) explore their attitudes and perceptions towards implementing evidence-based strategies for hypertension management in Lagos, Nigeria (n = 19)The quantitative data were analyzed using SPSS whereas responses from the stakeholders meeting were coded and analyzed using thematic approach and an implementation science framework, the COM-B (Capabilities, Opportunities, Motivations and Behavior) model, guided the mapping and interpretation of the data. Results Out of the 29 HIV clinics that participated in the study, 28 clinics were public, government-owned facilities with 394 HIV patients per month with varying capabilities, opportunities and motivations for integrating evidence-based hypertension interventions within their services for PLHIV. Majority of the clinics (n = 26) rated medium-to-low on the psychological capability domains, while most of the clinics (n = 25) rated low on the physical capabilities of integrating evidence-based hypertension interventions within HIV clinics. There was high variability in the ratings for the opportunity domains, with physical opportunities rated high in only eight HIV clinics, two clinics with a medium rating and nineteen clinics with a low rating. Social opportunity domain tended to be rated low in majority of the HIV clinics (n = 21). Lastly, almost all the HIV clinics (n = 23) rated high on the reflective motivation domain although automatic motivations tended to be rated low across the HIV clinics. Conclusion In this study, we found that with the exception of motivations, the relative capabilities whether physical or psychological and the relative opportunities for integrating evidence-based hypertension intervention within HIV clinics in Nigeria were minimal. Thus, there is need to strengthen the HIV clinics in Lagos for the implementation of evidence-based hypertension interventions within HIV clinics to improve patient outcomes and service delivery in Southwest Nigeria.

Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

“…We view these as the key facilitators for integrated HTN/HIV services in our setting. In agreement with the facilitators we identified for integrated HTN/HIV services, there is increasing demand for integrated rather than vertically oriented HTN and HIV services in low-and middle income countries (LMIC) [5,16,17,[27][28][29].…”

Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

“…We view these as the key facilitators for integrated HTN/HIV services in our setting. In agreement with the facilitators we identified for integrated HTN/HIV services, there is increasing demand for integrated rather than vertically oriented HTN and HIV services in low-and middle income countries (LMIC) [5,16,17,[27][28][29]. Although some studies have assessed barriers and facilitators for HTN care in the HIV program, this is the first study in Africa to assess factors that influence HTN/HIV integration using the CFIR.…”

Hypertension Care Cascade at a Large Urban HIV Clinic in Uganda: A Mixed Methods Study Using the Capability, Opportunity, Motivation for Behavior Change (COM-B) Model

“…Poor access to HTN medications and BP machines have been cited as key barriers to HTN control in SSA [23]. In our study, it was evident from patients and healthcare providers that this inevitably contributed to the poor HTN cascade at Mulago ISS.…”

“…The goal was to identify gaps in HTN care within a successful HIV clinic which could be targeted in future interventions. We used qualitative inquiry guided by the COM-B model to understand perceptions and experiences of PLHIV and healthcare providers on integrating HTN care into a large urban HIV program in East Africa [23].…”

“…Key barriers to integrated HTN/HIV care include poor access to HTN medications, low provider knowledge of HTN care, inappropriate task shifting, lack of evidence based treatment protocols and weak systems for monitoring and evaluation [21,[23][24][25][26].…”