Table 1 The RE-AIM framework adapted to the evaluation of HEARTS-based HIV/hypertension integration interventionÂ
RE-AIM dimensions and the operational definitions | Indicators/nature of data | Measurement and sources of data |
|---|---|---|
Reach (mixed methods) | ||
 Reach is the absolute number, proportion (%), and representativeness of individuals who participated in the integrated hypertension-HIV program. | Number and % of PLHIV who were screened for hypertension compared to baseline Number and % of PLHIV/ hypertension who were started on hypertension treatment compared to baseline Acceptability of integrated hypertension-HIV care | Routinely collected data on hypertension screening from the electronic medical records (EMR) Data on hypertension treatment from the hypertension register and EMR FGDs with PLHIV/hypertension IDIs with healthcare providers and PLHIV/hypertension |
Effectiveness (mixed methods) | ||
 Effectiveness is the impact of integrated hypertension-HIV care on outcomes, including potential negative effects, quality of life, and economic outcomes. | Number and % PLHIV/hypertension retained in hypertension/HIV treatment at 21 months Number and % PLHIV/hypertension with controlled hypertension at 21 months compared to baseline Number and % PLHIV/hypertension with HIV control (VL < 1000) at 21 months compared to baseline Number and % PLHIV/hypertension with side effects of hypertension treatment Number and %PLHIV/hypertension LTFU, transferred, and dead Side effects, quality of life, cost savings, and healthy lifestyle | Data on hypertension treatment from the hypertension register and EMR Data on viral load monitoring from the EMR IDI with healthcare providers and PLHIV/hypertension KII with healthcare providers and PLHIV/hypertension |
Adoption (mixed methods) | ||
 Adoption is the absolute number, proportion, and representativeness of healthcare providers, HIV clinic leaders, and MoH leaders who are willing to initiate and incorporate integrated hypertension-HIV care into HIV clinical settings. | Number and % of healthcare providers trained on WHO HEARTS protocol Number and % healthcare providers who were willing to participate in delivering integrated hypertension-HIV care compared to baseline Healthcare providers’ perception about the comfort, appropriateness, and relative advantage of integrated hypertension-HIV care | Attendance lists of healthcare provider training Review of patient screening and treatment records in EMR KII with healthcare providers at Mulago ISS Clinic |
Implementation (mixed methods) | ||
 Implementation refers to the healthcare provider’s and supervisors’ fidelity to the various elements of integrated hypertension-HIV care | Number and % of all planned activities implemented (training healthcare providers, SOPs, availability of tools for hypertension care) Barriers and facilitators to implementation | Review of the activity log for the project Review of patient screening and treatment records in EMR IDIs with the healthcare providers KII with MoH policymakers |
Maintenance (mixed methods) | ||
 Maintenance is the extent to which integrated hypertension-HIV care became institutionalized or part of the routine HIV clinical practices and policies as well as sustainment over time and reinforcing factors. | Active hypertension/HIV focal person peers N (%) follow-up contacts for clients in hypertension/HIV care Leveraging HIV program resources for integrated hypertension-HIV care Hypertension care integrated and supported in the national HIV program Number and adequacy of job aides available for use Availability of hypertension medicines and BP machines | Review of patient screening and treatment records in EMR Physical counting of BP machines IDIs with healthcare providers and PLHIV/hypertension KIIs with clinic leaders and MoH policymakers |