New Study Implements Integrated Care Approaches for Patients with HIV and Cardiovascular Disease

February 2025

According to the World Health Organization (WHO), an estimated 1.28 billion adults worldwide have hypertension, and most of them live in low- and middle-income countries. 

When untreated, hypertension, or high blood pressure, increases the risk of heart attack, stroke, and other health issues. Those concerns escalate when a patient also has HIV, with rates increasing as they age. 

Reflecting the effectiveness of HIV treatment, people with HIV are living longer. Botswana has been successful in implementing treatment for HIV, achieving the WHO goals of 95 percent on awareness of their diagnosis, treatment, and achieving viral suppression, a critical outcome needed for a healthier and longer life. 

As a result of this success, hypertension is increasingly seen in people with HIV and managing them can improve health outcomes for this population. By assessing the effectiveness and feasibility of integrating these two types of care into one clinic and one visit, the study provides valuable insights into how to optimize healthcare delivery and improve the quality of care. 

Unfortunately, integrated care approaches to ensure effective hypertension treatment are not commonly implemented. The InterCARE study is a type 2 single-arm hybrid effectiveness-implementation pilot study in Botswana designed to test the implementation and effectiveness of strategies to integrate hypertension into HIV clinics.

The study, “Quantitative outcomes of a type 2 single arm hybrid effectiveness implementation pilot study for hypertension-HIV integration in Botswana,” evaluates the feasibility and effectiveness of integrating hypertension management into existing HIV care services in Botswana.  

The study is led by Mosepele Mosepele, MB, BS from the University of Botswana, and supported by Lisa Hirschhorn, MD, MPH, director of the Ryan Family Center for Global Primary Care at the Robert J. Havey, MD Institute for Global Health and professor of Medical Social Sciences (Implementation Science) and Psychiatry and Behavioral Sciences at Feinberg School of Medicine. 

“The research is critical because it provides evidence of ways to better integrate hypertension and HIV care to improve health outcomes for individuals living with both conditions, addressing a major public health challenge,” Hirschhorn says. 

This study measures the implementation and effect of integration of hypertension care into existing HIV treatment programs in Botswana. Between October 2021 and November 2022, nearly 300 participants from two HIV clinics in Botswana participated in the research study. 

The team utilized three primary strategies: 

1. Health Worker Training: Educating healthcare providers on hypertension and cardiovascular disease management. 
2. Electronic Health Record (EHR) Adaptation: Modifying the HIV EHR system to incorporate hypertension and cardiovascular disease care components. 
3. Treatment Partner Support: Utilizing treatment partners to assist people living with HIV who also have hypertension. 

The study employs implementation research methods to assess implementation effectiveness and blood pressure control outcomes throughout the year. HIV viral suppression was also measured to assess the impact of the integration on HIV care. 

Results are used to inform a larger study which will continue through 2025 and will provide important insights into strategies that can integrate hypertension and HIV care, leading to better health outcomes for patients and more effective policies for Botswana and other countries in the region. 

This study was funded by the United States of America National Institute of Health (NIH) via the National Heart, Lung and Blood Institute (NHLBI): Federal Award Identification Number (FAIN) UG3HL154499. 

“The need for integrating hypertension management into HIV care is critical because many individuals living with HIV also suffer from hypertension, and integrating these treatments can enhance patient outcomes and streamline healthcare delivery in resource-limited settings,” Hirschhorn says. 

Lisa Hirschhorn, MD, MPH is a member of Robert J. Havey, MD Institute for Global Health, Institute for Public Health and Medicine (IPHAM), Northwestern University Clinical and Translational Sciences Institute (NUCATS), Institute for Innovations in Developmental Sciences, and Institute for Sexual and Gender Minority Health and Wellbeing. 

To learn more about the Center for Global Cardiovascular Health, visit their website. 

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