Optimizing Antihypertensive Care for Tanzanians Living with HIV: Effectiveness Outcomes from the COACH Pilot Trial

Background: In Tanzania, many people living with HIV (PLWH) 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 two public HIV clinics in Moshi, Tanzania. Methods: COACH included six monthly community health worker (CHW)-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 six months (<140/<90 mmHg). Secondary effectiveness outcomes included systolic and diastolic BP (SBP/DBP), hypertension knowledge (HK-LS score), medication adherence, BMI, and five-year cardiovascular risk. Paired t-tests and McNemar’s tests compared baseline and follow-up values. Results: Of 100 participants, 96 completed follow-up. Six-month BP control was achieved in 73 (76%). Mean SBP decreased from 159.6 mmHg at baseline to 130.8 mmHg at follow-up (-28.9 mmHg, p<0.001); DBP decreased from 100.8 to 85.5 mmHg (-15.4 mmHg, p<0.001). HK-LS 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 BMI decreased from 27.0 to 26.6 kg/m 2 (p=0.019), and the proportion with ≥20% five-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 PLWH in Tanzania.