Abstract
BackgroundPeople living with HIV (PWH) in Africa have higher burden of cardiovascular diseases (CVD) compared to the general population, probably due to increased burden of hypertension (HTN). In this study, we explored nurses’ perceptions of factors that may influence the integration of an evidence-based task-shifting/sharing strategy for hypertension control (TASSH) into routine HIV care in Lagos, Nigeria.MethodsUsing group concept mapping, we examined the perceptions of 22 nurses from HIV clinics in Lagos. Participants responded to a focused prompt on the barriers and facilitators of integrating TASSH into HIV care; next, separate focus groups generated relevant statements on these factors; and statements were then sorted and rated on their importance and feasibility of adoption to create cluster maps of related themes. The statements and cluster maps were categorized according to the Consolidated Framework for Implementation Research (CFIR) domains.ResultsAll study participants were women and with 2 to 16 years’ experience in the provision of HIV care. From the GCM activities, 81 statements were generated and grouped into 12 themes. The most salient statements reflected the need for ongoing training of HIV nurses in HTN management and challenges in adapting TASSH in HIV clinics. A synthesis of the cluster themes using CFIR showed that most clusters reflected intervention characteristics and inner setting domains. The potential challenges to implementing TASSH included limited hypertension knowledge among HIV nurses and the need for on-going supervision on implementing task-shifting/sharing.ConclusionsFindings from this study illustrate a variety of opinions regarding the integration of HTN management into HIV care in Nigeria. More importantly, it provides critical, evidence-based support in response to the call to action raised by the 2018 International AIDS Society Conference regarding the need to implement more NCD-HIV integration interventions in low-and middle-income countries through strategies, which enhance human resources. This study provides insight into factors that can facilitate stakeholder engagement in utilizing study results and prioritizing next steps for TASSH integration within HIV care in Nigeria.
Highlights
People living with Human immunodeficiency viruses (HIV) (PWH) in Africa have higher burden of cardiovascular diseases (CVD) compared to the general population, probably due to increased burden of hypertension (HTN)
Findings from this study illustrate a variety of opinions regarding the integration of HTN management into HIV care in Nigeria
It provides critical, evidence-based support in response to the call to action raised by the 2018 International Acquired immunodeficiency syndrome (AIDS) Society Conference regarding the need to implement more noncommunicable diseases (NCDs)-HIV integration interventions in low-and middle-income countries through strategies, which enhance human resources
Summary
People living with HIV (PWH) in Africa have higher burden of cardiovascular diseases (CVD) compared to the general population, probably due to increased burden of hypertension (HTN). Addressing the health worker shortage and HTN control in Nigeria through task-shifting/sharing Similar to other low- and middle-income countries (LMICs), the acute shortage of healthcare workers is a major barrier to HTN control in Nigeria, which has only 3 physicians per 10,000 population [8]. This shortage of healthcare workers limits Nigeria’s capacity to control hypertension at the primary care level, where the majority of PWH receive care. The current task-shifting/sharing policy in Nigeria focuses on priority areas such as family and reproductive health, HIV, tuberculosis, and malaria, there is currently no evidence of the policy’s implementation in the integration of HTN management and control into HIV care
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