Integrating Hypertension and Cardiovascular Disease Care into Existing HIV Service Package in Botswana (InterCARE)-Statin Sub-study

PROJECT SUMMARY While Botswana has attained the UNAIDS 95-95-95 target for HIV treatment and is the first country with severe HIV epidemic to reach the milestone of elimination of mother-to-child HIV transmission, there is a growing concern about long-term risk of non-communicable diseases among people living with HIV (PWH). In 2022, a large international study (that included Botswana) focussed on prevention of heart attacks and strokes, called REPRIEVE, revealed that use of cholesterol lowering medicines (statins) such as Pitavastatin© can reduce the risk of heart attacks and stroke among PWH. The US department of human and health services has since released a guideline for use of statins among PWH. Similarly, the British HIV clinicians society issued a similar, but easier to implement statin guideline for PWH. Thus, in the proposed research, we will develop and test new strategies that target PWH plus diagnosis of hypertension to be initiated on statin therapy. Our proposed study will leverage a study of PWH and hypertension in Botswana. The program will be developed in collaboration with policy makers, healthcare providers, community leaders, patients, etc in Botswana. Following initial engagement with different informants, we will then use the new implementation strategy to conduct a type 2 hybrid multi-component cluster randomized trial to optimize evidence based implementation (EBI) uptake of statin therapy.