Table 1. Recommended elements for successful hypertension and human immunodeficiency virus (HIV) management integration.

Category	Recommended elements	Considerations for the HIV-infected population	Used in Malawi hypertension-HIV program
Policy	Population-level interventions (sodium reduction) National clinical guidelines	Guidelines that consider drug interactions for hypertension treatment	Developed algorithms for hypertension treatment that would minimize interactions with antiretrovirals
System strengthening	Service delivery: Standardized assessment Simplified management protocols Blood pressure measurement devices CVD risk estimation Task shifting Training Clinical mentorship Supply chain: Improved medication procurement and sustained availability Access to fixed-dose combination medications Community engagement: Linkage to care Community health workers Leveraging existing infrastructure/systems	Benefit of angiotensin-converting enzyme inhibitors Leverage HIV medication supply chain improvements Enhanced adherence to complicated regimens to treat HIV and co-morbidities Enhance PEPFAR service delivery	Service delivery: Standardized assessment Simplified management protocols Blood pressure measurement devices Task shifting Training Clinical mentorship Supply chain: Improved medication procurement and sustained availability Leveraging existing infrastructure/systems
Innovation	Promotion and use of available technology Electronic health records mHealth Telemedicine Point-of-care laboratory testing Improve availability of fixed-dosed combination medications (e.g., medications with 2 active ingredients)		Electronic health records
Education	Community: Mass media campaigns Population-level health promotion Clinical: Training of healthcare workers during formal education and in clinical practice Culturally tailored educational materials	Leverage platforms for HIV education to include chronic disease education	Clinical: Training of healthcare workers during formal education and in clinical practice Culturally tailored educational materials
Monitoring/evaluation	Tracking/indicators Registries/cohort monitoring Clinical feedback loop (chart reviews, line listing, clinic-level control estimates, etc.) Performance metrics for clinicians Program evaluation using process and outcome indicators	Track HIV-specific indicators (e.g., ART adherence)	Tracking/indicators Registries/cohort monitoring Clinical feedback loop (chart reviews, line listing, clinic-level control estimates, etc.) Performance metrics for clinicians Program evaluation using process and outcome indicators
Optimal hypertension care delivery	Standardized screening and diagnosis using certified and calibrated devices Education about disease prevention and counseling using culturally appropriate lifestyle modifications Standardized treatment protocols Task shifting Cohort monitoring		Standardized screening and diagnosis using certified and calibrated devices Education about disease prevention and counseling using culturally appropriate lifestyle modifications Standardized treatment protocols Task shifting Cohort monitoring

Abbreviations: ART, antiretroviral therapy; CVD, cardiovascular disease; mHealth, mobile health; PEPFAR, President’s Emergency Plan for AIDS Relief. Cohort monitoring: use of longitudinal patient registers or electronic medical records systems to regularly monitor progress and outcomes.