Z 32201 - Effects of a Package of Evidence-based Interventions and Implementation Strategies Based on WHO PEN for People Living With HIV and Cardio-metabolic Conditions in Lusaka, Zambia: A Type II Hybrid Effectiveness-implementation Stepped Wedge Trial

Brief Summary

Detailed Description

This hybrid effectiveness-implementation stepped wedge trial will be used to evaluate the clinical effectiveness and implementation outcomes and strategies. Investigators will evaluate the effects of TASKPEN on the primary clinical effectiveness outcome of dual HIV/ cardio-metabolic non-communicable diseases (NCD) control at 12 months, and the secondary implementation outcome of intervention reach in the clinic population. Other secondary outcomes will include longitudinal changes in the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator, changes in quality of life per the WHOQOL-HIV-Bref, modification of grade III hypertension, and HIV viral suppression at different accepted thresholds (i.e., \<1,000 c/mL, \<200 c/ml, \<50 c/ml). A cluster will be defined as one health facility and their associated catchment area population (i.e., together a study site). Sequential crossover of sites will take place, from control to intervention, until all 12 clusters (i.e., all 12 sites) are exposed to the intervention before the end of the study. Trained and experienced study staff will conduct a bio-behavioral survey at baseline with approximately 1,020 participants across all study sites before introduction of the TASKPEN intervention. After this baseline survey is completed, four randomly selected clusters (i.e., 4 facilities) will be switched to the TASKPEN intervention (the first orange shaded step in Figure 3) over a \~4-week introduction/ "wash out" period, and then continue with TASKPEN implementation until the end of the trial. Six months later, another survey with 1,020 participants who have not participated previously will be done across all 12 sites at time T1 right before a second block of two clusters (i.e., clusters 5 and 6) are switched to the TASKPEN intervention. After another 6 months, the survey will be repeated, this time as a midline survey, and another two clusters (i.e., clusters 7 and 8) will be switched to the TASKPEN intervention after survey completion. Six months later, at time T3, another survey will be completed with 1,020 participants who have not volunteered previously right before the final four randomly selected clusters (i.e., clusters 9 through 12) switch to the TASKPEN intervention. After all facilities/ sites have received the intervention for at least 6 months, a final "end-line survey" will be administered at time T4. Once the end-line survey is completed, a total of approximately 5,100 participants will have completed a survey. To overcome the limitations inherent to cross-sectional assessments of patient outcomes, and to facilitate collection of more detailed longitudinal data, a "nested cohort," will be embedded in the larger trial reflecting a representative sample of approximately 320 survey participants with co-morbid cardio-metabolic NCDs identified through study surveys to carefully follow longitudinal clinical outcomes in PLHIV with these conditions. Embedded in the trial will be concurrent mixed methods data collection to assess implementation outcomes and to understand the mechanisms by which the evidence-based intervention package and associated implementation strategies did, or did not, achieve their intended effects or acted through the conceptual model of change.

Primary Outcomes

Secondary Outcomes

• Percent of Participants with Improvement in 10-year ASCVD Risk Score(up to 24 months)
• Percent of Participants with Severe Hypertension(1, 12 and 24 months)
• Average Change in Haemoglobin A1c and Fasting Glucose(Baseline up to 24 months)
• Ideal Cardiovascular Health (CVH)(1, 12, and 24 months)
• Percent of Participants with HIV-1 Viral Suppression(0, 12, and 24 months)
• Number of Participants Retained in HIV Care(0, 12, and 24 months)
• Variation of Medication Possession Ratio (MPR) ART(0, 12 and 24 months)
• Variation of Medication Possession Ratio (MPR) NCD Medications(0, 12 and 24 months)
• Change in Blood Pressure Control from Baseline to Month 12(Baseline, Month 12)
• Change in Blood Pressure Control from Baseline to Month 24(Baseline, Month 24)
• Number of Participants with Severe Hypertension(up to 24 months)
• Number of Participants with HIV-1 Viral Suppression(0, 12, and 24 months)
• Percent of Participants Retained in HIV Care(1, 12, and 24 months)
• Number of Participants with an Increase in Quality of Life (QOL)(up to 24 months)
• Percent of Participants with an Increase in Quality of Life(up to 24 months)