Hypertension control in integrated HIV and chronic disease clinics in Uganda in the SEARCH study

Abstract

Background: There is an increasing burden of hypertension (HTN) across sub-Saharan Africa where HIV prevalence is the highest in the world, but current care models are inadequate to address the dual epidemics. HIV treatment infrastructure could be leveraged for the care of other chronic diseases, including HTN. However, little data exist on the effectiveness of integrated HIV and chronic disease care delivery systems on blood pressure control over time.

Methods: Population screening for HIV and HTN, among other diseases, was conducted in ten communities in rural Uganda as part of the SEARCH study (NCT01864603). Individuals with either HIV, HTN, or both were referred to an integrated chronic disease clinic. Based on Uganda treatment guidelines, follow-up visits were scheduled every 4 weeks when blood pressure was uncontrolled, and either every 3 months, or in the case of drug stock-outs more frequently, when blood pressure was controlled. We describe demographic and clinical variables among all patients and used multilevel mixed-effects logistic regression to evaluate predictors of HTN control.

Results: Following population screening (2013-2014) of 34,704 adults age ≥ 18 years, 4554 individuals with HTN alone or both HIV and HTN were referred to an integrated chronic disease clinic. Within 1 year 2038 participants with HTN linked to care and contributed 15,653 follow-up visits over 3 years. HTN was controlled at 15% of baseline visits and at 46% (95% CI: 44-48%) of post-baseline follow-up visits. Scheduled visit interval more frequent than clinical indication among patients with controlled HTN was associated with lower HTN control at the subsequent visit (aOR = 0.89; 95% CI 0.79-0.99). Hypertension control at follow-up visits was higher among HIV-infected patients than uninfected patients to have controlled blood pressure at follow-up visits (48% vs 46%; aOR 1.28; 95% CI 0.95-1.71).

Conclusions: Improved HTN control was achieved in an integrated HIV and chronic care model. Similar to HIV care, visit frequency determined by drug supply chain rather than clinical indication is associated with worse HTN control.

Trial registration: The SEARCH Trial was prospectively registered with ClinicalTrials.gov : NCT01864603.

Keywords: HIV/AIDS; Hypertension; Integrated care; Sub-Saharan Africa.

Conflict of interest statement

Ethics approval and consent to participate

This study and all consent procedures were approved by ethical review boards of Makerere University School of Medicine (Kampala, Uganda) and the University of California, San Francisco (USA). All participants provided verbal informed consent at the CHC in their preferred language with fingerprint biometric confirmation of agreement. Verbal consent was provided in lieu of written consent as the CHC activities presented no more than minimal risk of harm to subjects and did not involve procedures for which written consent would otherwise be provided, and because of limited literacy in the study population.

Consent for publication

Not applicable

Competing interests

V.J. has received grant support from Gilead Sciences. D.V.H. has received non-financial support from Gilead Sciences. All authors have no other competing of interest to declare.

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Figures

Fig. 1

Population screened for HIV and hypertension and linked to hypertension care within one year in the SEARCH Study