Adapting an intervention to improve hypertension care for adults with HIV in Tanzania: Co-design of the Community Health Worker Optimization of Antihypertensive Care in HIV (COACH) intervention

IntroductionThere is a large burden of uncontrolled hypertension among people with HIV (PWH) in sub-Saharan Africa (SSA), including in Tanzania. Yet, few evidence-based interventions to improve hypertension control have been adapted for use in PWH in this region. This study describes the adaptation process of an evidence-based hypertension intervention to develop the Community Health Worker Optimization of Antihypertensive Care in HIV (COACH) intervention, a multi-component strategy designed to improve blood pressure control among Tanzanians with HIV and hypertension. MethodsA 27 member interdisciplinary intervention design team consisting of HIV and hypertension clinicians, nurses, community health workers (CHWs), pharmacists, social workers and patients with HIV and hypertension from Tanzania met biweekly from May 2024 to October 2024. The design team used the Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) framework supported by participatory co-design principles to iteratively adapt the intervention to the local context. ResultsTo address the unique needs of PWH and hypertension in Tanzania, we iteratively adapted an evidence-based CHW intervention for hypertension care originally developed in Asia (Control of Blood Pressure and Risk Attenuation--COBRA), resulting in development of the COACH intervention for the HIV clinical setting in Tanzania. COACH, includes five key components: 1) CHW-delivered hypertension counselling integrated into HIV clinic visits, 2) Integration of routine blood pressure monitoring and referrals for antihypertensive medication management in the HIV clinic, 3) Hypertension management training for HIV providers and creation of an antihypertensive treatment algorithm, 4) CHW care navigation and coordination of hypertension care in the HIV clinic, and 5) Subsidization of antihypertensive medications. ConclusionsCOACH is one of the first contextually-tailored interventions developed to address hypertension care among PWH in Tanzania. A pilot feasibility study of the intervention is in process and future studies will evaluate the implementation and clinical effectiveness outcomes of the COACH intervention. The rigorous, systematic application of the ADAPT-ITT framework to iteratively develop COACH supports reproducibility of the adaptation process, and strengthens the potential for COACH core components to be highly relevant for PWH with hypertension in other resource limited settings worldwide.