# Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SAIA-HTN)

> **NIH NIH R01** · UNIVERSITY OF WASHINGTON · 2021 · $668,567

## Abstract

Undiagnosed and untreated hypertension (HTN) is one of the largest drivers of cardiovascular disease
(CVD) in sub-Saharan Africa (sSA). Across sSA, evidence-based, clinical guidelines to screen and manage
hypertension exist; however, country level application is low and uneven due to lack of service readiness,
uneven health worker motivation, lack of accountability for health worker performance and poor integration
of HTN screening and management with chronic care services. In Mozambique – like many countries with
high HIV burden – the HIV treatment platform was the first broadly implemented chronic care service. With
large numbers of patients on anti-retroviral treatment (850,000 in Mozambique), it presents a unique
opportunity to standardize and scale hypertension screening and management. Low-cost, systems level
interventions are effective and efficient approaches to improve linked cascade services, and may be
effective for routinizing HTN diagnosis and management within existing chronic care services;
addressing both individual and systems-level barriers; improving flow through the HTN cascade; and
ultimately improving patient level outcomes.
 The Systems Analysis and Improvement Approach (SAIA) is designed to optimize cascade performance,
is feasible for frontline healthcare workers and managers, and is applicable to optimize the HTN testing and
treatment cascade for people living with HIV (PLHIV) across multiple contexts. We have successfully piloted
SAIA for the HTN cascade for PLHIV, and as HTN screening and management is mainstreamed into chronic
care services in sSA (including in Mozambique), demonstrating SAIA-HTN potential effectiveness as an
adaptable, scalable model for broad implementation. The overall goal of SAIA-HTN is to evaluate a model
for systematic assessment and improvement of HTN diagnosis and management services for PLHIV in
Mozambique. Our specific aims are to: (1) Determine the effectiveness of SAIA-HTN on HTN cascade
optimization for HIV-infected individuals; (2) Determine the drivers of SAIA-HTN intervention implementation
heterogeneity across facilities; (3) Determine the costs and cost-effectiveness of SAIA-HTN for care cascade
optimization. We will deploy a cluster randomized trial to evaluate the impact of the SAIA-HTN intervention
on hypertension management in 8 intervention and 8 control facilities. Effectiveness will be measured via
HTN cascade flow measures for PLHIV and HTN and HIV clinical outcomes. Intervention costs will be
assessed from the payer perspective (e.g. MOH), and cost effectiveness analysis conducted to estimate the
incremental costs for additional patients passing through the HTN cascade steps, and the cost per additional
disability-adjusted life year averted (DALY). The implementation process will be described using focus group
discussions and key informant interviews analyzed using the Consolidated Framework for Implementation
Research, with complementary data from study logs to describe fi...

## Key facts

- **NIH application ID:** 10153876
- **Project number:** 5R01HL142412-03
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Sarah Odell Gimbel
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $668,567
- **Award type:** 5
- **Project period:** 2019-05-01 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10153876

## Citation

> US National Institutes of Health, RePORTER application 10153876, Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Care Cascade for HIV-infected Individuals (SAIA-HTN) (5R01HL142412-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10153876. Licensed CC0.

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