Evaluating linkage to care for hypertension after community-based screening in rural Uganda

Abstract

Objectives: To determine the frequency and predictors of hypertension linkage to care after implementation of a linkage intervention in rural Uganda.

Methods: During a multidisease screening campaign for HIV, diabetes and hypertension in rural Uganda, hypertensive adults received education, appointment to a local health facility and travel voucher. We measured frequency and predictors of linkage to care, defined as visiting any health facility for hypertension management within 6 months. Predictors of linkage to care were calculated using collaborative-targeted maximum likelihood estimation (C-TMLE). Participants not linking were interviewed using a standardised instrument to determine barriers to care.

Results: Over 5 days, 2252 adults were screened for hypertension and 214 hypertensive adults received a linkage intervention for further management. Of these, 178 (83%) linked to care within 6 months (median = 22 days). Independent predictors of successful linkage included older age, female gender, higher education, manual employment, tobacco use, alcohol consumption, hypertension family history and referral to local vs. regional health centre. Barriers for patients who did not see care included expensive transport (59%) and feeling well (59%).

Conclusions: A community health campaign that offered hypertension screening, education, referral appointment and travel voucher achieved excellent linkage to care (83%). Young adults, men and persons with low levels of formal education were among those least likely to seek care.

Keywords: Uganda; community-based screening; evaluation; hypertension; rural.

© 2014 John Wiley & Sons Ltd.

Figures

Figure 1. Hypertension care cascade

A concept map outlining each step involved in the successful treatment of hypertension. This process begins with community or clinic-based hypertension screening initiatives. Once hypertension is diagnosed, the next key steps - linkage, retention, and re-engagement - ensure continued engagement in care. These steps are crucial to retain patients in care and achieve successful blood pressure control. HTN = hypertension. Adapted from: Mugavero MJ, Norton WE, Saag MS. Health care system and policy factors influencing engagement in HIV medical care: piecing together the fragments of a fractured health care delivery system. Clin Infect Dis. 2011;52:S238–S246.

Figure 2. Study schema for the hypertension linkage to care intervention

281 adults from Kakyerere parish were eligible to participate in the study; however, 214 adults received the hypertension linkage to care intervention and formed the study cohort. 178 (83%) of these linked to care within 6 months. 30 subjects were determined to have not linked to care while 6 were lost to follow-up. Persons who did not link were tracked and interviewed to determine barriers to care.