Implementation Science

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Browsing Implementation Science by Subject "NCD screening at ART Clinic"

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    Barriers and facilitators to screening for dyslipidaemia, hypertension and diabetes among people living with HIV aged 40 years and above at ART clinics in district hospitals in Southern Malawi
    (2021-11-18) Katundu, Kondwani
    Study Type: The study will utilise a mixed-methods (convergent) approach. Background: Malawi is ranked among the countries in the world with the highest burden of atherosclerotic cardiovascular diseases (ASCD) among people living with HIV (PLWH). Dyslipidaemia, Hypertension, and diabetes mellitus (DM) are major risk factors for ASCD and lead to debilitating consequences such as stroke. There is a gap in the effectiveness in identifying and managing hypertension dyslipidaemia and DM among PLWH in many public health facilities across Malawi. Investigating the local barriers and facilitators in the Malawian setting is critical to creating better implementation strategies for the effective screening and management of these cardiovascular risk factors in district hospitals of the country. Study Objectives: The objectives of this study are: (a) to determine the proportion of PLWH aged 40 years and older who are evaluated for dyslipidaemia, hypertension and DM in routine care at district hospital ART clinics in Southern Malawi (b) to identify the barriers and facilitators to screening for dyslipidaemia, hypertension and DM among PLWH) aged 40 years and older at ART clinics in district hospitals in Southern Malawi. Methods: A mixed-methods (convergence) approach will be used to collect the study data. Firstly, we will quantitatively collect retrospective data on the performance of five randomly selected district hospital ART clinics in Southern Malawi to screen for hypertension, dyslipidaemia and DM in routine care. From these clinics, we will purposefully select three clinics rated as highest, intermediate and low on the screening performance for hypertension, which is the expected standard routine assessment in these clinics, according to Malawi standard clinical guidelines for the management of PLWH. In the three clinics we will collect qualitative data guided by the Consolidated Framework for Implementation Research (CFIR), and we will assess for three major domains namely the intervention, the inner setting and the characteristics of individuals. Expected findings and dissemination: We expect to find a relatively high prevalence of screening for hypertension since it is in the national management guidelines. However, we hypothesize that the prevalence for screening for DM and dyslipidaemia will be lower due to the lack of inclusion in the national guidelines and screening resources in district hospitals. We expect to identify the barriers and facilitators to the integration of screening of hypertension, DM and dyslipidaemia in the ART clinics. The results once analysed will be published in an international scientific journal and will be presented both at local and regional or international conferences. Published results will also be submitted to the district hospitals engaged, the HIV and non-communicable diseases units of the MalawiMinistry of Health, the College of Medicine Research and Ethics Committee (COMREC) and the Kamuzu University of Health Sciences Library.