# Integrated Community-based Treatment of HIV and Hypertension in Zambia

> **NIH NIH K23** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2020 · $8,336

## Abstract

ABSTRACT
An estimated 10-30% of the 21.8 million HIV-infected adults in sub-Saharan Africa have hypertension, the
single largest risk factor for cardiovascular disease (CVD). The consequences of untreated hypertension are
magnified in HIV-infected individuals who are at 50% greater risk of experiencing a CVD event than HIV-
uninfected persons, even after controlling for traditional CVD risk factors. Although the scale up of HIV
treatment means that millions of patients are now in contact with the health system, poor uptake of
hypertension treatment in these same populations persists. As a result, fewer than 10% of hypertensive
patients on HIV treatment have controlled blood pressure. Because HIV and hypertension management share
many barriers (e.g., opportunity costs of accessing care), emerging solutions for HIV treatment also represent
critical opportunities to improve access to, and sustainability of, treatment for other chronic conditions in Africa.
The proposed K23 study seeks to understand the implementability and effects of adding hypertension
treatment into the “community adherence group” (CAG) model for HIV treatment in Zambia. In Aim 1, we will
evaluate the implementation of the hypertension care into this model by measuring adoption, fidelity of
implementation, and sustainability of access to hypertension medications over time. In Aim 2, we will use a
before-and-after design to evaluate the effectiveness of introduced practices on blood pressure. In Aim 3, we
will use in-depth interviews and focus groups among both health care workers and patients to understand how
to optimize the acceptability, fit, and reach of the model for future dissemination and eventual extension into
HIV-uninfected populations with hypertension. I am currently immersed in a project supported by the Bill and
Melinda Gates Foundation that seeks to implement and scale up the CAG model for HIV treatment in Zambia.
My hands-on knowledge of CAG implementation will make the addition of a hypertension component into the
CAG model immediately feasible. Findings from the scientific aims proposed will inform an R01 evaluating the
dissemination of an integrated HIV and hypertension treatment CAG model and an R21 to expand the model to
HIV-uninfected patients.
The overarching goal of this proposed mentored career development award is to support my development into
an independent implementation science researcher with a focus on health systems innovations for chronic
diseases in resource-limited settings. The career development aims for this K23 are to obtain expertise in (1)
the application of implementation science theory to research design and evaluation; (2) analytic methods for
correlated and longitudinal data; (3) the use of qualitative methods in implementation research and (4)
positioning research questions and findings to optimize influence on practice and policy. This plan will be
carried out with coursework and guidance of an international team of mentors with exp...

## Key facts

- **NIH application ID:** 9920767
- **Project number:** 5K23HL137457-04
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Monika Roy
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $8,336
- **Award type:** 5
- **Project period:** 2017-05-15 → 2020-05-25

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9920767

## Citation

> US National Institutes of Health, RePORTER application 9920767, Integrated Community-based Treatment of HIV and Hypertension in Zambia (5K23HL137457-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9920767. Licensed CC0.

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