Optimizing Antihypertensive Care for Tanzanians Living With HIV: Effectiveness Outcomes From the COACH Pilot Trial.
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2026-08
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Abstract
Background
In Tanzania, many people living with HIV have uncontrolled hypertension, yet integration of hypertension management into HIV care remains limited. The Community Health Worker Optimization of Antihypertensive Care in HIV (COACH) intervention was developed to integrate standardized hypertension management into HIV clinic workflows.Setting
A single-arm pilot trial was conducted from December 2024 to September 2025 at 2 public HIV clinics in Moshi, Tanzania.Methods
COACH included 6 monthly community health worker-delivered hypertension education sessions within HIV clinic visits, monthly blood pressure (BP) checks, care coordination, subsidized antihypertensive medications, a standardized treatment algorithm, and provider training. The primary effectiveness outcome was BP control at 6 months (<140/<90 mm Hg). Secondary effectiveness outcomes included systolic and diastolic BP, Hypertension Knowledge Level Scale score, medication adherence, body mass index, and 5-year cardiovascular risk. Paired t tests and McNemar tests compared baseline and follow-up values.Results
Of 100 participants, 96 completed follow-up. Six-month BP control was achieved in 73 participants (76%). Mean systolic BP decreased from 159.6 mm Hg at baseline to 130.8 mm Hg at follow-up (-28.9 mm Hg, P < 0.001); diastolic BP decreased from 100.8 to 85.5 mm Hg (-15.4 mm Hg, P < 0.001). Hypertension Knowledge Level Scale scores increased from 15.0 to 20.4 (P < 0.001), and self-reported adherence improved from 14.0% to 95.0% (P < 0.001). Mean body mass index decreased from 27.0 to 26.6 kg/m2 (P = 0.019), and the proportion with ≥20% 5-year cardiovascular risk declined from 33% to 7% (P < 0.001).Conclusions
COACH resulted in substantial improvements in BP control, hypertension knowledge, medication adherence, and cardiovascular risk among people living with HIV in Tanzania.Type
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Publication Info
Hertz, Julian T, Faraan Rahim, Claire Wang, Arthi Vaidyanathan, Lisa Wanda, Francis M Sakita, Blandina T Mmbaga, Godfrey L Kweka, et al. (2026). Optimizing Antihypertensive Care for Tanzanians Living With HIV: Effectiveness Outcomes From the COACH Pilot Trial. Journal of acquired immune deficiency syndromes (1999), 101(8). pp. 896–906. 10.1097/qai.0000000000003874 Retrieved from https://hdl.handle.net/10161/35431.
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Scholars@Duke
Julian T Hertz
Julian Hertz, MD, MSc, is an Associate Professor of Emergency Medicine & Global Health. He graduated summa cum laude from Princeton University and attended medical school at Duke University, where he received the Dean's Merit Scholarship and the Thomas Jefferson Award for leadership. He completed his residency training in emergency medicine at Vanderbilt University Medical Center and his fellowship in Global Health at Duke.
Dr. Hertz's primary interests include global health, implementation science, and undergraduate and graduate medical education. Dr. Hertz's research focuses on using implementation science methods to improve cardiovascular care both locally and globally. His current projects involve developing interventions to improve acute myocardial infarction care in Tanzania, to improve management of hypertension among Tanzanians with HIV, and to improve post-hospital care among patients with multimorbidity in East Africa.
Dr. Hertz has received numerous awards for clinical, educational, and research excellence, including the Duke Emergency Medicine Faculty Teacher of the Year Award, the Duke Emergency Medicine Faculty Clinician of the Year Award, and the Duke Emergency Medicine Faculty Researcher of the Year Award. He has also received the Golden Apple Teaching Award from the Duke medical student body, the Duke Master Clinician/Teacher Award, and the Global Academic Achievement Award from the Society of Academic Emergency Medicine.
Tazeen Hasan Jafar
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
Nathan Maclyn Thielman
Broadly, my research focuses on a range of clinical and social issues that affect persons living with or at risk for HIV infection in resource-poor settings. In Tanzania, our group is applying novel methods to optimize HIV testing uptake among high-risk groups. We recently demonstrated that the Discrete Choice Experiment (DCE), a form of stated preference survey research, is a robust tool for identifying (a) which characteristics of HIV testing options are most preferred by different populations and (b) which tradeoffs individuals make in evaluating testing options. Building on more than a decade of productive HIV testing research in the Kilimanjaro Region, the next phase of our NIMH funded project will test the hypothesis that DCE-derived HIV testing options significantly increases rates of testing among groups at high risk for HIV infection. This work holds promise not only for optimizing HIV testing uptake in the Kilimanjaro Region, but also for applying novel tools in the service of translational epidemiology and implementation research.
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