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Screening for Hypertension in adolescents living with HIV: Protocol for a cluster randomized trial to improve
Raphael Adu-Gyamfi1, Juliana Enos2, Kwame Yeboah3
1School of Public Health, University of Ghana, Accra, Ghana.
Insights
A new intervention aims to improve hypertension screening for adolescents living with HIV by training healthcare workers. This will increase adherence to clinical guidelines and improve cardiovascular health monitoring in this vulnerable population.
Area of Science:
- Public Health
- Clinical Practice Guidelines
- HIV/AIDS Research
Background:
- Cardiovascular disease is increasing in persons living with HIV, with hypertension as a key contributor.
- Adolescents perinatally infected with HIV face higher risks for hypertension due to prolonged exposure to the virus and antiretroviral drugs.
- Current clinical guidelines for hypertension screening in adolescents living with HIV are underutilized, with blood pressure checks often missed during visits.
Purpose of the Study:
- To evaluate the impact of a theory-based intervention on healthcare workers' adherence to hypertension screening guidelines for adolescents living with HIV.
- To improve the implementation of clinical practice guidelines for cardiovascular risk management in adolescents with HIV.
- To increase the proportion of adolescents living with HIV who receive regular blood pressure monitoring.
Main Methods:
- A multi-facility cluster-randomized study involving 20 antiretroviral therapy sites in Ghana.
- Intervention group staff received a multicomponent theory of planned behavior-based training, job aids, and equipment.
- Data collected from 400 adolescent patient folders (ages 10-17) to assess changes in blood pressure screening rates six months post-intervention.
Main Results:
- The study is designed to measure the change in the proportion of adolescents living with HIV whose blood pressure was checked during clinical visits post-intervention.
- The intervention is hypothesized to increase adherence to hypertension screening protocols.
- Evidence will be generated on the effectiveness of the intervention in improving guideline implementation.
Conclusions:
- The study will provide evidence on the effectiveness of a multicomponent intervention for improving adherence to hypertension screening guidelines among healthcare workers.
- Successful implementation could lead to better cardiovascular risk management for adolescents living with HIV.
- This research addresses a critical gap in monitoring and managing hypertension in a vulnerable pediatric population.
Background:
Although AIDS-related deaths have reduced with increased access to antiretroviral care, cardiovascular disease-related morbidities among persons living with HIV are rising. Contributing to this is the higher incidence of Hypertension among Persons Living with HIV. The duration of exposure to the virus and antiretroviral drugs plays a vital role in the pathogenesis, putting perinatally infected children and adolescents at higher risk than behaviorally-infected ones, supporting the calls for increased surveillance of Hypertension among them. Despite the availability of guidelines to support this surveillance, the blood pressure (BP) of adolescents living with HIV (ADLHIV) is not checked during clinical visits. This study aims to assess the effect of a theory-based intervention on healthcare workers' adherence to the guidelines for hypertension screening among adolescents.
Methods:
A multi-facility cluster-randomized study will be conducted. The clusters will be 20 antiretroviral therapy sites in the Greater Accra Region of Ghana with the highest adolescent caseload. Data will be extracted from the folders of adolescents (10-17 years) who received care in these facilities six months before the study. The ART staff of intervention facilities will receive a multicomponent theory of planned behaviour-based intervention. This will include orientation on hypertension risk among ADLHIV, provision of job aids and pediatric sphygmomanometers. Six months after the intervention, the outcome measure will be the change from baseline in the proportion of ADLHIV whose BP was checked during clinical visits. The calculated sample size is 400 folders.
Implications Of Findings:
This study will generate evidence on the effectiveness of a multicomponent theory-based intervention for improving the implementation of clinical practice guidelines.
Trial Registration:
PACTR202205641023383.
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