Optimizing Antihypertensive Care for Tanzanians Living With HIV: Effectiveness Outcomes From the COACH Pilot Trial.

Abstract

BackgroundIn 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.SettingA single-arm pilot trial was conducted from December 2024 to September 2025 at 2 public HIV clinics in Moshi, Tanzania.MethodsCOACH 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.ResultsOf 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).ConclusionsCOACH resulted in substantial improvements in BP control, hypertension knowledge, medication adherence, and cardiovascular risk among people living with HIV in Tanzania.