ABOUT PULESA
Strengthening the Blood Pressure Care and Treatment Cascade for Ugandans Living with
HIV–Implementation Strategies to SAve Lives (PULESA-Uganda) study is an implementation
science study whose aim is to improve hypertension care among people living with HIV
(PLHIV) in urban and peri-urban Uganda in a scalable and sustainable pattern. The study is
evaluating two strategies for integrating hypertension and HIV services in 16 HIV clinics in
Kampala and Wakiso Districts.
The study is being led by Infectious Diseases Research Collaboration in collaboration with
Makerere University College of Health Sciences, the Uganda Heart Institute, Yale University,
University of Washington, Research Triangle International and the Uganda Ministry of
Health.
There are two phases for implementation, the first phase was a formative study whose
overall objective was to assess patients’ and health care providers’ knowledge, attitudes,
practices, and routines relating to hypertension and barriers and facilitators to
implementation of integrated HIV-hypertension care in HIV clinical settings.
The second phase is a stepped wedge cluster randomized trial of 16 HIV clinics in Kampala
and Wakiso districts, whose overall objective is to determine the effectiveness and evaluate
the implementation strategy’s economic and financial sustainability of two strategies for
integrating HIV-hypertension.
The implementation strategies are;
1) The HTN-BASIC intervention will consist of providing consistent access to diagnostic
equipment and evidence-based antihypertensive drugs at no cost to the PLHIV with
hypertension. A consistent supply of three anti-hypertensive drugs will be supplied to each
clinic in the trial.
2) The HTN-PLUS intervention will have all the components of HTN-BASIC but will also
include a more intensive package of activities for clinic staff, including training on
hypertension management, adoption of differentiated service delivery for hypertension,
remote patient monitoring, and a performance improvement program. This enhanced
intervention was developed by the team in consultation with clinicians, healthcare
managers and policy makers through a human-centered design process.
Sixteen clinics will be randomized to the order in which they will begin intervention, with
two clinics initiating the intervention every two months after a run-in period. Clinic data will
be collected during the control period, run-in period, and the intervention phase, and an
additional longitudinal cohort study will continue for a few months after the intervention
phase has concluded to gather more granular detail on how hypertension care is being
implemented at the HTN-BASIC and HTN-PLUS sites.
Study objectives are: –
1. To evaluate the effectiveness of two strategies for integrating HIV-Hypertension in 16 HIV
clinics in Kampala and Wakiso.
2. To determine the implementation outcomes of two implementation strategies
3. To evaluate the economic and financial sustainability of the integrated care strategies
Study Site: 16 HIV clinics (Eight in Wakiso and Eight clinics in Kampala) Collaborators: Infectious Diseases Research Collaboration (IDRC), Uganda Ministry of Health (MoH), Makerere University, Uganda Heart Institute (UHI), University of Washington, Yale University and Makerere University Joint AIDS Program (MJAP)
Principal Investigators: Fred C. Semitala; (Contact PI)
Chris T. Longenecker; MPI
Study Sponsor: National Heart Lung and Blood Institute (NHLBI) of National
Institute of Health (NIH) with partnership Fogarty International Center (FIC) under the
grant UH3-HL-154501.
