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Multicenter Study
. 2017 Aug 1;75(4):472-479.
doi: 10.1097/QAI.0000000000001437.

Effectiveness of an Integrated Approach to HIV and Hypertension Care in Rural South Africa: Controlled Interrupted Time-Series Analysis

Soter Ameh  1 , Kerstin Klipstein-Grobusch, Eustasius Musenge, Kathleen Kahn, Stephen Tollman, Francesc Xavier Gómez-Olivé
Affiliations
Multicenter Study

Effectiveness of an Integrated Approach to HIV and Hypertension Care in Rural South Africa: Controlled Interrupted Time-Series Analysis

Soter Ameh et al. J Acquir Immune Defic Syndr. .

Abstract

Background: South Africa faces a dual burden of HIV/AIDS and noncommunicable diseases. In 2011, a pilot integrated chronic disease management (ICDM) model was introduced by the National Health Department into selected primary health care (PHC) facilities. The objective of this study was to assess the effectiveness of the ICDM model in controlling patients' CD4 counts (>350 cells/mm) and blood pressure [BP (<140/90 mm Hg)] in PHC facilities in the Bushbuckridge municipality, South Africa.

Methods: A controlled interrupted time-series study was conducted using the data from patients' clinical records collected multiple times before and after the ICDM model was initiated in PHC facilities in Bushbuckridge. Patients ≥18 years were recruited by proportionate sampling from the pilot (n = 435) and comparing (n = 443) PHC facilities from 2011 to 2013. Health outcomes for patients were retrieved from facility records for 30 months. We performed controlled segmented regression to model the monthly averages of individuals' propensity scores using autoregressive moving average model at 5% significance level.

Results: The pilot facilities had 6% greater likelihood of controlling patients' CD4 counts than the comparison facilities (coefficient = 0.057; 95% confidence interval: 0.056 to 0.058; P < 0.001). Compared with the comparison facilities, the pilot facilities had 1.0% greater likelihood of controlling patients' BP (coefficient = 0.010; 95% confidence interval: 0.003 to 0.016; P = 0.002).

Conclusions: Application of the model had a small effect in controlling patients' CD4 counts and BP, but showed no overall clinical benefit for the patients; hence, the need to more extensively leverage the HIV program for hypertension treatment.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Monthly probabilities of having a CD4 count >350 cells/mm3 after propensity score matching in the ICDM pilot and comparison facilities in the Bushbuckridge municipality, 2011–2013.
FIGURE 2.
FIGURE 2.
Monthly probabilities of having a BP <140/90 mm Hg after propensity score matching in the ICDM pilot and comparison facilities in the Bushbuckridge municipality, 2011–2013.
See this image and copyright information in PMC

References

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