World AIDS Day 2024: Multi-level perspectives on factors that impact hypertension screening, treatment, and management among people with HIV in South Africa
Published in Sustainability, Biomedical Research, and General & Internal Medicine
Cardiovascular disease is the leading cause of death worldwide, and people living with HIV are at a higher risk. One major risk for cardiovascular disease is high blood pressure (i.e., hypertension), but many people with HIV, especially in South Africa, don't get the care they need for it. While there are guidelines for diagnosing and treating hypertension, routine blood pressure checks are often lacking. Since many people with HIV are already receiving care, combining hypertension treatment with HIV care could help improve health outcomes for this population.
What led to this study?
Our team interviewed and held group discussions with clinic staff and patients to understand the challenges and needs for better managing hypertension alongside HIV care. This study reports key factors that affect the way hypertension care is delivered, such as knowledge, support, and social and environmental influences that impact patients’ engagement with care. The findings will help develop better strategies to improve care by addressing the barriers and leveraging strengths identified in the healthcare system and community.
Why is this study important?
Despite hypertension being a major risk factor for cardiovascular disease, most people with HIV do not receive the recommended screening and treatment. Addressing hypertension alongside HIV care could significantly reduce the risk of cardiovascular disease and improve overall health outcomes, but there is not enough theory-driven research to create feasible and effective strategies for combining hypertension and HIV care in resource limited settings in a way that fits the specific needs of different clinical actors and people affected by these conditions. The findings from this study will help guide the design of more effective healthcare strategies and interventions, ensuring better care for people with HIV while optimizing the use of available healthcare resources.
Did this study find any differences between perspectives of different stakeholders?
One unexpected difference between the two groups was their view on the seriousness of the diseases. Patients seemed to think hypertension was more urgent, while clinic staff felt that treating HIV should be the main focus for people dealing with both conditions. Overall, the study emphasizes the need for better education for both patients and healthcare workers about hypertension and highlights the importance of improving healthcare systems to better manage both conditions.
What is the wider significance of the study findings?
Both patients and clinic staff pointed out that a lack of proper facility resources and clinic organization made it difficult to regularly check and treat high blood pressure. Many staff members also felt they didn’t have enough training on how to care for chronic conditions like high blood pressure. Despite these challenges, there was strong support among clinical actors for combining HIV and hypertension care. Staff suggested incorporating a stronger focus on chronic disease care in regularly held clinical trainings, providing additional resources, and offering rewards to motivate staff. However, they stressed that for this to work long-term, bigger changes are needed in the healthcare system. Interviews with people living with HIV and hypertension revealed key insights into their experiences with managing their condition. Many patients were motivated to change their lifestyle because they feared serious health problems, like strokes, caused by uncontrolled hypertension. However, they often found clinics difficult to navigate due to long wait times and lack of organization. Additionally, patients managed their condition with the help of family and community groups, but most expressed a need for more guidance and tools, like blood pressure machines, to help them monitor their health at home.
How were these findings used to inform future work?
A broader stakeholder group provided input on these data, allowing for a comprehensive understanding of how hypertension care could be improved in the South African context. Participatory research methods were then used to inform the design of implementation strategies aimed at promoting the adoption and implementation of guideline-recommended hypertension screening and management practices in local primary care settings. By centering the design of those strategies on data collected in this study, our team aims to overcome challenges at the patient, provider, and clinic-level that may hinder improved cardiovascular disease control in this high-risk population.
Geldsetzer P, Manne-Goehler J, Marcus ME, et al. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults. Lancet. 2019, 394(10199):652-662. doi: 10.1016/S0140-6736(19)30955-9.
Wollum, A, Gabert R, McNellan CR, et al. Identifying gaps in the continuum of care for cardiovascular disease and diabetes in two communities in South Africa: Baseline findings from the HealthRise project. PLOS ONE. 2018; 13(3): e0192603.
Johnson LCM, Khan SH, Ali MK, et al. Understanding barriers and facilitators to integrated HIV and hypertension care in South Africa. Implement Sci Commun. 2024;5(1):87. doi: 10.1186/s43058-024-00625-5.
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Implementation Science Communications
An official companion journal to Implementation Science and a forum to publish research relevant to the systematic study of approaches to foster uptake of evidence based practices and policies that affect health care delivery and health outcomes, in clinical, organizational, or policy contexts.
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Learning From the Past and Shaping the Future
Implementation Science has published 2,197 papers since its inception in 2006 (as of May 27, 2026). Implementation Science Communications has published 938 papers since it began in 2019 (also as of May 27, 2026). In addition to papers published in these two journals, a larger number of papers focusing on implementation science in health care have been published in other journals over the last 20 years, conservatively around 22,300. This is based on a PubMed search using a specific search string[1], conducted on May 27, 2026. It is important to note that landmark papers in the field were published before 2006. Our purpose in marking this anniversary is to reflect on the field as a whole.
While much of the growth in the literature has come from high-income countries, there has been an increase in the number and scope of papers from lower and middle-income countries, fueling the overall growth.
Arguably, the growth in the literature and underlying research studies shows that the science and practice of implementation have moved from the periphery to mainstream health research. We are interested in papers that document and analyze the change over the last couple of decades—although the history of the field prior to 2006 is also of interest—and propose how this shapes the future of the field. This may be based on bibliographic or citation analysis, surveys among researchers, or other sources. Papers that only review the past, without analysis and future direction, will not be seen as responding to this call.
Examples of topics include, but are not limited to:
- Content analysis or systematic reviews of empirical publications from Implementation Science and/or Implementation Science Communications
- Content analysis of editorials and research agenda-setting articles from both journals, including papers focusing on implementation science published in other journals
- Bibliographic/citation analysis of publications over the 20 years of IS, including other papers published in other journals
- Analyses of geographic, disciplinary, authorship, funding, or institutional patterns in implementation science
Submissions should include critical interpretive analysis of existing literature and provide new insights, ideas, and thoughts from reflection on the existing literature.
This Collection welcomes submissions of a range of article types. Should you wish to submit to this Collection, please read the submission guidelines of the journal you are submitting to, i.e., Implementation Science or Implementation Science Communications, to confirm that the type is accepted by the journal you are submitting to.
Articles for this Collection should be submitted via our submission systems in Implementation Science or Implementation Science Communications. During the submission process, you will be asked whether you are submitting to a Collection. Please select "Learning From the Past and Shaping the Future" from the dropdown menu.
Articles will undergo the standard peer-review process of the journal in which they are considered, Implementation Science or Implementation Science Communications, and are subject to all of the journal’s standard policies. Articles will be added to the Collection as they are published.
The Editors have no competing interests with the submissions that they handle through the peer-review process. The peer review of any submissions for which the Editors have competing interests is handled by another Editorial Board Member who has no competing interests.
[1] ("Implementation Science"[Mesh] OR "implementation science"[tiab] OR "implementation research"[tiab] OR "dissemination and implementation"[tiab] OR "translation science"[tiab] OR "knowledge translation"[tiab]) AND 2006:2026[dp]
Publishing Model: Open Access
Deadline: Mar 09, 2027
Breaking Frameworks: Revisiting, Extending, Integrating, and Theorizing Implementation Frameworks
The field of implementation science has amassed a large number of frameworks3,4,5. These are sometimes also called models, but because the term “model” is used in many other contexts in research, we will use the term “framework.” While many of these frameworks express a goal of supporting research in the implementation of evidence-based practices and programs, researchers and especially new entrants to the field continue to express confusion and uncertainty about how to use existing frameworks and which to use for what purposes. New frameworks are often developed without clarity about how they fit within the existing corpus of frameworks.
Despite the large number of frameworks 4, their use often reflects a lack of deep understanding of the content of the frameworks. Implementation researchers often describe frustration with existing frameworks while continuing to use them. A major issue is that once published in a peer-reviewed venue, there is no clear path to suggest changes or updates to the frameworks. A few, such as the Consolidated Framework for Implementation Research (CFIR)6, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework7,8, and the RE-AIM framework9, have been updated through processes determined by a relatively small group of researchers10; others remain essentially fixed as they were published, or updated once but not again11,12. This can lead to reification of the frameworks in their original form. These issues may constitute a major “sticking point” for advancing the science of implementation, as well as contributing to complexity for implementation practitioners who use frameworks as tools developed through the science. Emerging global health priorities, including health equity, structural racism, coloniality, climate and planetary health, digital transformation, and policy implementation, raise questions about whether existing frameworks adequately capture power, history, resource constraints, political economy, community agency, and cross-setting adaptation13. The increased geographic scope of published studies adds to concerns about whether theories and frameworks current in the literature support the broader scope.
We also note the importance of understanding the function of existing frameworks, most clearly addressed in the seminal 2015 paper by Nilsen describing an initial taxonomy of theories, models, and frameworks in implementation science5. We note that this paper is now over a decade old. Proposing additional taxonomic categories of frameworks, models, and theories is an important step yet to be taken.
This background informs this collection proposal. We are calling for manuscripts to address the issues, which may include methods (what methods can be used to update or extend existing frameworks), perspective or commentary manuscripts (why is this important), and empirical papers offering new insights, updates, and extensions of existing frameworks. We would also welcome papers that explicitly focus on theorizing based on existing frameworks, focusing on prediction and explanation rather than description14. However, manuscripts proposing new frameworks will be considered only if they clearly demonstrate how the proposed contribution builds on, revises, synthesizes, tests, or challenges existing frameworks, and why a new framework or a substantial extension is necessary. The existing body of frameworks and models within implementation science and practice constitutes an important catalog of knowledge. Our goal is to build on that existing knowledge.
Examples of topics include, but are not limited to:
- Innovative papers that develop new substantive theories or significant theoretical extensions to existing theories
- Methods for classifying and categorizing existing frameworks
- Proposing new domains and constructs for existing determinant frameworks
- Synthesizing across existing process frameworks to describe common elements and areas of departure
- Practical guidance on how to use existing tools such as the “Assess the Dissemination and Implementation Models Webtool” or useful new tools and approaches to help people select and use existing frameworks (these are likely to be assessed for Implementation Science Communications rather than Implementation Science)
This Collection welcomes submissions of a range of article types. Should you wish to submit to this Collection, please read the submission guidelines of the journal you are submitting to, i.e., Implementation Science or Implementation Science Communications, to confirm that the type is accepted by the journal you are submitting to.
Articles for this Collection should be submitted via our submission systems in Implementation Science or Implementation Science Communications. During the submission process, you will be asked whether you are submitting to a Collection. Please select "Breaking Frameworks: Revisiting, Extending, Integrating, and Theorizing Implementation Frameworks" from the dropdown menu.
Articles will undergo the standard peer review process of the journal in which they are considered, Implementation Science or Implementation Science Communications, and are subject to all of the journal’s standard policies. Articles will be added to the Collection as they are published.
The Editors have no competing interests with the submissions that they handle through the peer-review process. The peer review of any submissions for which the Editors have competing interests is handled by another Editorial Board Member who has no competing interests.
Publishing Model: Open Access
Deadline: Mar 09, 2027
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