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Table 1 Targeted barriers and components of the implementation strategy to integrate HTN care into Mulago ISS clinic:

From: Improved hypertension control at six months using an adapted WHO HEARTS-based implementation strategy at a large urban HIV clinic in Uganda

Barriers targeted

COM-B Domain

Intervention function

Behavior change technique (BCT)

Mode of delivery

Component 1: Health education, medication adherence, and lifestyle counseling

 Patient lack of knowledge of HTN risk, complications and self-management

Psychological capability

Education

Information about health consequences of HTN

Health education by HTN/HIV peer educators

 Healthcare providers and patients lack knowledge of HTN-HIV drug interactions

Psychological capability

Education

Information about health consequences of HTN

Health education by nurse and dispenser

 Patients prioritize adherence to ART over HTN medications

Reflective motivation

Persuasion

Information about health consequences of HTN

Adherence counseling for both anti-hypertensives and ART by nurse

Component 2: Routine HTN screening during each clinic visit

 Inadequate supply of automated BP machines

Physical opportunity

Environmental restructuring

Adding objects to the environment

Provide 2 automated BP machines to HIV clinic

Component 3: Task shifting of HTN screening and treatment

 HTN/HIV peer educators’ skills to measure BP

Physical capability

Training

Demonstration of the behavior

Nurses to mentor HTN/HIV peer educators to measure BP

 HTN prescriptions are mainly done by doctors; limited task shifting to clinical officers and nurses

Social opportunity

Modeling

Demonstration of the behavior

Train nurses on HTN treatment through CME and mentoring

Component 4: Evidence based HTN treatment protocol

 Lack of simple evidence-based treatment protocol for HTN

Physical opportunity

Enablement

Social support

Provide stepwise evidence-based treatment protocol to all clinical rooms

Component 5: Consistent supply of HTN medicines free to patients

 Lack of on-site HTN medications  despite demand from  patients and providers

Physical opportunity

Enablement

Social support

Pharmacy assistant to make timely orders of protocol anti-hypertensive medicines

 Cost of buying anti-hypertensive medicines is high; patients can’t afford

Physical opportunity

Enablement

Social support

Provide anti-hypertensive medicines to patients at no cost

Component 6: Inclusion of HTN-specific monitoring and evaluation tools

 Lack of monitoring indicators for HTN

Psychological capability

Enablement

Goal setting

Apply WHO HTN monitoring indicators and mentor providers on them

 Lack of performance targets and review of HTN care quality

Automatic motivation

Persuasion

Feedback on behavior

Develop and share quarterly targets with providers. Monthly performance review meetings

 Lack of data collection tools and data bases for HTN care

Physical opportunity

Enablement

Social support

Integrate HTN data elements into HIV data collection tools and EMR. Print and avail HTN register and patient treatment cards

  1. CME Continuing medical education, EMR Electronic medical records