Background Despite success in HIV treatment, diagnosis and management of hypertension (HTN) and cardiovascu‑ lar disease (CVD) remains suboptimal among people living with HIV (PLWH) in Botswana, with an overall HTN control of only 19% compared to 98% HIV viral suppressed. These gaps persist despite CVD primary care national guidelines and availability of free healthcare including antihypertensive medications. Our study aims to develop and test strate‑ gies to close the HTN care gap in PLWH, through integration into HIV care, leveraging the successful national HIV care and treatment program and strategies. Methods The InterCARE trial is a cluster randomized controlled hybrid type 2 efectiveness-implementation trial at 14 sites designed to enroll 4652 adults living with HIV and HTN plus up to 2326 treatment partners. Primary out‑ comes included efectiveness (HTN control) and implementation outcomes using the Reach Efectiveness Adop‑ tion Implementation and Maintenance framework, with explanatory mixed methods used to understand variability in outcomes. InterCARE trial’s main strategies include healthcare worker HTN and CVD care training plus long-term practice facilita‑ tion, electronic health record (EHR) documentation of key indicators and use of reminders, and use of treatment part‑ ners to provide social support to people living with HIV and HTN. InterCARE started with formative research to identify contextual factors infuencing care gaps using the Consolidated Framework for Implementation Research. Results were used to adapt initial and develop additional implementation strategies to address barriers and leverage facilita‑ tors. The package was pilot tested in two clinics, with fndings used to further adapt or add strategies for the clinical trial

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