Integrated Hypertension and HIV Care Cascades in an HIV Treatment Program in Eastern Uganda: A Retrospective Cohort Study

Abstract

Background: Persons living with HIV (PLHIV) are at increased risk of cardiovascular disease. Integration of services for hypertension (HTN), the primary cardiovascular disease risk factor, into HIV care programs is recommended in Uganda, though, uptake has been limited. We sought to compare the care cascades for HTN and HIV within an HIV program in Eastern Uganda.

Methods: We conducted a retrospective cohort study of all PLHIV enrolled in 3 HIV clinics between 2014 and 2017. We determined the proportion of patients in the following cascade steps over 12 months: Screened, Diagnosed, Initiated on treatment, Retained, Monitored, and Controlled. Cascades were analyzed using descriptive statistics and compared using χ and t tests.

Results: Of 1649 enrolled patients, 98.5% were initiated on HIV treatment, of whom 70.7% were retained in care, 100% had viral load monitoring, and 90.3% achieved control (viral suppression). Four hundred fifty-six (27.7%) participants were screened for HTN, of whom 46.9% were diagnosed, 88.1% were initiated on treatment, 57.3% were retained in care, 82.7% were monitored, and 24.3% achieved blood pressure control. There were no differences in any HIV cascade step between participants with HIV alone and those with both conditions.

Conclusions: The HIV care cascade approached global targets, whereas the parallel HTN care cascade demonstrated notable quality gaps. Management of HTN within this cohort did not negatively impact HIV care. Our findings suggest that models of integration should focus on screening PLHIV for HTN and retention and control of those diagnosed to fully leverage the successes of HIV programs.

Conflict of interest statement

Conflicts of Interest and Source of Funding

Authors have no conflict of interest. Research presented in this manuscript was funded by Fogarty International Center and the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (D43TW010540).

Figures

Figure 1.

Integrated care cascades for HIV and HTN. The bars above each cascade step represent the number of participants included in each step, while the bars below each cascade step represent the percentage of participants lost from the previous step. The grey bar represents the entire cohort of 1,649 participants with HIV, the blue bar represents the HIV cascade for those with HIV and HTN, and the red bar represents the HTN cascade for those with HIV and HTN. Error bars reflect the 95% confidence interval. HTN=Hypertension