Effects of a Package of Evidence-based Interventions and Implementation Strategies Based on WHO PEN for People Living With HIV and Cardio-metabolic Conditions in Lusaka, Zambia

NCT ID: NCT05950919

Last Updated: 2025-08-24

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 5620 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-05-30
• Study Completion Date: 2025-12-01

Brief Summary

The purpose of this study is to evaluate the effects of a multi-level intervention known as "TASKPEN," adapted from the World Health Organization (WHO) Package of Essential Noncommunicable Disease Interventions (WHO-PEN) for the Zambian public health system, on clinical and implementation outcomes for persons living with HIV (PLHIV) with co-morbid cardio-metabolic conditions in Lusaka, Zambia.

Detailed Description

This hybrid effectiveness-implementation stepped wedge trial will be used to evaluate the clinical effectiveness and implementation outcomes and strategies. Investigators will evaluate the effects of TASKPEN on the primary clinical effectiveness outcome of dual HIV/ cardio-metabolic non-communicable diseases (NCD) control at 12 months, and the secondary implementation outcome of intervention reach in the clinic population. Other secondary outcomes will include longitudinal changes in the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator, changes in quality of life per the WHOQOL-HIV-Bref, modification of grade III hypertension, and HIV viral suppression at different accepted thresholds (i.e., <1,000 c/mL, <200 c/ml, <50 c/ml). A cluster will be defined as one health facility and their associated catchment area population (i.e., together a study site). Sequential crossover of sites will take place, from control to intervention, until all 12 clusters (i.e., all 12 sites) are exposed to the intervention before the end of the study. Trained and experienced study staff will conduct a bio-behavioral survey at baseline with approximately 1,020 participants across all study sites before introduction of the TASKPEN intervention. After this baseline survey is completed, four randomly selected clusters (i.e., 4 facilities) will be switched to the TASKPEN intervention (the first orange shaded step in Figure 3) over a ~4-week introduction/ "wash out" period, and then continue with TASKPEN implementation until the end of the trial. Six months later, another survey with 1,020 participants who have not participated previously will be done across all 12 sites at time T1 right before a second block of two clusters (i.e., clusters 5 and 6) are switched to the TASKPEN intervention. After another 6 months, the survey will be repeated, this time as a midline survey, and another two clusters (i.e., clusters 7 and 8) will be switched to the TASKPEN intervention after survey completion. Six months later, at time T3, another survey will be completed with 1,020 participants who have not volunteered previously right before the final four randomly selected clusters (i.e., clusters 9 through 12) switch to the TASKPEN intervention. After all facilities/ sites have received the intervention for at least 6 months, a final "end-line survey" will be administered at time T4. Once the end-line survey is completed, a total of approximately 5,100 participants will have completed a survey.

To overcome the limitations inherent to cross-sectional assessments of patient outcomes, and to facilitate collection of more detailed longitudinal data, a "nested cohort," will be embedded in the larger trial reflecting a representative sample of approximately 320 survey participants with co-morbid cardio-metabolic NCDs identified through study surveys to carefully follow longitudinal clinical outcomes in PLHIV with these conditions.

Embedded in the trial will be concurrent mixed methods data collection to assess implementation outcomes and to understand the mechanisms by which the evidence-based intervention package and associated implementation strategies did, or did not, achieve their intended effects or acted through the conceptual model of change.

Conditions

HIV; Non Communicable Diseases

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: OTHER
• Blinding Strategy: NONE

Study Groups

TASKPEN

The TASKPEN intervention is a package of five evidence-based intervention (EBI) components that enhances WHO's Package of Essential Noncommunicable Disease Intervention for Primary Care (WHO-PEN) and includes a multi-faceted implementation strategy centred on service integration within routine HIV care settings. The EBI components and multi-faceted strategy have been adapted to the Zambian setting during recently completed formative work."

Group Type: EXPERIMENTAL

TASKPEN

Intervention Type: OTHER

The package of integrated HIV/NCD services:

1. Integrated non-communicable/HIV care ("one stop shop" for services)

2. WHO PEN protocols, algorithm, & training materials adapted for Zambia

3. Access to cardio-metabolic condition screening & laboratory monitoring

4. Non-communicable disease-focused electronic medical record module

5. Strengthened NCD medication supply chain

Standard of Care

Screening, diagnosis, and treatment of cardio-metabolic NCDs are generally unavailable in the clinical departments where most PLHIV seek and receive health services. When these services are available, they tend to be siloed and offered only for hypertension in general outpatient medical settings that provide urgent care-like services. Healthcare workers do not have protocolized algorithms for NCD management in HIV service delivery settings. NCD equipment is often unavailable in ART and differentiated service delivery (DSD) clinics; most health facilities do not offer haemoglobin A1c or lipid panel testing; and fragmented NCD supply chain management systems mean that essential medications for the management of hypertension, diabetes, and dyslipidemia are often unavailable

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

TASKPEN

The package of integrated HIV/NCD services:

1. Integrated non-communicable/HIV care ("one stop shop" for services)

2. WHO PEN protocols, algorithm, & training materials adapted for Zambia

3. Access to cardio-metabolic condition screening & laboratory monitoring

4. Non-communicable disease-focused electronic medical record module

5. Strengthened NCD medication supply chain

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

In-depth interview (IDI) participants must be

• HIV-positive adults
• =18 years of age
• survey and/or cohort participants and
• had received HIV and/or NCD services at a TASKPEN study site.

Focus group discussion (FGD) participants must be:

• =18 years of age;
• a non-physician health care worker (NPHW) or community health worker (CHW)/ lay health provider involved with TASKPEN or integrated HIV/NCD service delivery; and
• generally familiar with HIV and/or NCD service delivery at their facility.

Key informant interview (KII) participants must be:

• =18 years of age;
• a facility-level ART, DSD, out-patient department (OPD), or relevant clinic leader/ manager/ in-charge, or policy maker at district, provincial, or national level in Zambia; and
• generally familiar with HIV and/or NCD-related issues in their community.

Implementation questionnaire participants must be:

• HIV-positive adults
• =18 years of age
• who had exposure to the TASKPEN intervention at a study site OR
• =18 years of age,
• a facility-level healthcare provider or manager at district, provincial, or national level in Zambia, and
• familiar with the TASKPEN intervention.

Costing study participants must be:

• HIV-positive adults
• =18 years of age
• who had received HIV and/or NCD services at a TASKPEN study site OR
• =18 years of age and
• a facility-level healthcare provider or manager at facility, district, provincial, or national level in Zambia, and generally familiar with HIV and/or NCD-related issues.

Exclusion Criteria

For the nested cohort, inclusion (n=320) participants will need to have been enrolled in a study survey and have evidence of one or more of the following cardio-metabolic conditions or risk factors at the time of the survey:

• Any current tobacco use (any tobacco use within 30 days of the survey, whether daily or non-daily use);
• Hypertension as defined by WHO PEN/ HEARTS (i.e., systolic blood pressure (SBP) =140 mmHg and/or diastolic blood pressure (DBP) =90 mmHg);
• Diabetes mellitus as defined by WHO PEN/ HEARTS (i.e., random plasma glucose = 11.1 mmol/L, fasting plasma glucose = 7 mmol/L, and/or hemoglobin A1c = 48 mmol/mol or =6.5%; and/or compatible clinical diagnosis);
• Prediabetes (defined as having impaired fasting glucose of 6.1 to 6.9 mmol/L and/or haemoglobin A1c 42 to 48 mmol/mol or between 6.0-6.4%); and/or
• Dyslipidaemia (defined as total cholesterol =5.2 mmol/L or low-density lipoprotein =3.4 mmol/L).
• Investigators will exclude adults who have no documented evidence of HIV infection, or who do not have a cardio-metabolic NCD or risk factor of interest. Investigators will also exclude people who did not participate in a patient survey, plan to transfer their HIV care to another site, or are unwilling/ unable to provide written informed consent.

• Investigators will exclude adult IDI participants who have no evidence of having received HIV and/or NCD services at the sites during the study period, adult implementation questionnaire
• participants who were not exposed/ familiar with the TASKPEN intervention, as well as - people unwilling or unable to provide written informed consent.
• Investigators will exclude any potential IDI, FGD, or KII study participant if they are unwilling or unable to provide written informed consent.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role: collaborator

Centre for Infectious Disease Research in Zambia

OTHER

Sponsor Role: collaborator

University of Zambia

OTHER

Sponsor Role: collaborator

Ministry of Health, Zambia

OTHER_GOV

Sponsor Role: collaborator

Fogarty International Center of the National Institute of Health

NIH

Sponsor Role: collaborator

University of North Carolina, Chapel Hill

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Michael Herce, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of North Carolina

Wilbroad Mutale, MBChB, MPhil, PhD

Role: PRINCIPAL_INVESTIGATOR

Centre for Infectious Disease Research in Zambia

Locations

Bauleni Health Center

Lusaka, , Zambia

Site Status: RECRUITING

Chawama 1st Level Hospital

Lusaka, , Zambia

Site Status: RECRUITING

Chelstone Urban Health Center

Lusaka, , Zambia

Site Status: RECRUITING

Chipata 1st Level Hospital

Lusaka, , Zambia

Site Status: RECRUITING

Kabwata Urban Health Center

Lusaka, , Zambia

Site Status: RECRUITING

Kalingalinga Urban Health Center

Lusaka, , Zambia

Site Status: RECRUITING

Kamwala Urban Health Center

Lusaka, , Zambia

Site Status: RECRUITING

Kanyama 1st Level Hospital

Lusaka, , Zambia

Site Status: RECRUITING

Makeni Urban Health Center

Lusaka, , Zambia

Site Status: RECRUITING

Mtendere Health Center

Lusaka, , Zambia

Site Status: RECRUITING

Ng'ombe Urban Health Center

Lusaka, , Zambia

Site Status: RECRUITING

Railway Urban Health Center

Lusaka, , Zambia

Site Status: RECRUITING

Countries

Zambia

Central Contacts

Chilambwe Mwila, MSc

Role: CONTACT

Chilambwe.Mwila@cidrz.org

260 966 608354

Christy Frimpong, MPH

Role: CONTACT

christiana.frimpong@cidrz.org

Facility Contacts

Chilambwe Mwila

Role: primary

chilambwe.mwila@cidrz.org

Chilambwe Mwila

Role: primary

Chilambwe.Mwila@cidrz.org

Chilambwe Mwila

Role: primary

Chilambwe.Mwila@cidrz.org

Chilambwe Mwila

Role: primary

Chilambwe.Mwila@cidrz.org

Chilambwe Mwila

Role: primary

Chilambwe.Mwila@cidrz.org

Role: backup

Chilambwe Mwila

Role: primary

Chilambwe.Mwila@cidrz.org

Chilambwe Mwila

Role: primary

Chilambwe.Mwila@cidrz.org

Chilambwe Mwila

Role: primary

Chilambwe.Mwila@cidrz.org

Chilambwe Mwila

Role: primary

Chilambwe.Mwila@cidrz.org

Chilambwe Mwila

Role: primary

Chilambwe.Mwila@cidrz.org

Chilambwe Mwila

Role: primary

Chilambwe.Mwila@cidrz.org

Chilambwe Mwila

Role: primary

Chilambwe.Mwila@cidrz.org

References

Herce ME, Bosomprah S, Masiye F, Mweemba O, Edwards JK, Mandyata C, Siame M, Mwila C, Matenga T, Frimpong C, Mugala A, Mbewe P, Shankalala P, Sichone P, Kasenge B, Chunga L, Adams R, Banda B, Mwamba D, Nachalwe N, Agarwal M, Williams MJ, Tonwe V, Pry JM, Musheke M, Vinikoor M, Mutale W. Evaluating a multifaceted implementation strategy and package of evidence-based interventions based on WHO PEN for people living with HIV and cardiometabolic conditions in Lusaka, Zambia: protocol for the TASKPEN hybrid effectiveness-implementation stepped wedge cluster randomized trial. Implement Sci Commun. 2024 Jun 6;5(1):61. doi: 10.1186/s43058-024-00601-z.

Reference Type: DERIVED

PMID: 38844992 (View on PubMed)

Other Identifiers

4UH3HL156389-03

Identifier Type: NIH

Identifier Source: secondary_id

View Link

22-2252

Identifier Type: -

Identifier Source: org_study_id