Download This Paper
Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.
A Multi-Component Integrated HIV and Hypertension Care Model Improves Hypertension Screening and Control in Rural Uganda: A Cluster Randomized Trial
29 Pages Posted: 11 Dec 2024
More...Abstract
Introduction: The prevalence of hypertension (HTN) is increasing among people living with HIV (PLHIV) across sub-Saharan Africa. However, little data exist on the effectiveness of integrated HIV and HTN care delivery systems on blood pressure (BP) screening and control.Methods: We conducted a cluster-randomized trial among PLHIV (≥18 years) to evaluate a multicomponent integrated HIV/HTN care model versus standard-of-care in 26 districts (13/arm) in Southwestern Uganda. The intervention included: 1) health worker (HW) training on integration; 2) promoting routine HTN screening and care; 3) improvement of the health management information system, 4) WhatsApp messages for data coordination among HWs. Both arms received BP machines, Non-Communicable Diseases (NCD) registers, patient cards and buffer stock HTN medicines. At baseline and annually, we randomly sampled PLHIV, reviewed their health records, administered surveys and measured BP. The primary endpoint was recent HTN screening at 24-months (BP measurement within 6 months). Secondary endpoints included change in HTN control (BP<140/90mmHg) from 12-to-24-months among intervention participants. All analyses accounted for clustering. Findings: Between November 2020 to March 2023, we conducted three cross-sectional surveys. At baseline (n=2645), recent HTN screening was low: 1% in the intervention and 0.5% in the SOC. At 12 months (n=3142), recent HTN screening was 42% in the intervention compared with 6% in the SOC for a risk difference (RD)=36% (95%CI:26-46%; p<0.001). At 24 months (n=3603), recent HTN screening was 55% (95%CI:45-64%) higher in the intervention (77%) versus SOC (22% p<0.001). Similar effects were seen for women (RD=55%), men (RD=56%), adults aged 18-40years (RD=55%), and aged 41+years (RD=54%). In the intervention arm among persons with prior diagnosis, HTN control improved from 33% at 12-months to 57% at 24-months: difference=24% (95%CI:17-30%; p<0.001).Interpretation: Integrated HIV/HTN care models improved HTN screening and BP control among PLHIV and presents opportunities to improve HTN care and reduce NCD related morbidity and mortality.
Keywords: Hypertension, HIV, Integration, Non-Communicable Diseases (NCDs), Leveraging HIV infrastructure, Health services, PLHIV, screening, Uganda and Africa. -
Suggested Citation: Suggested Citation