Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug 15;81(5):552-561.
doi: 10.1097/QAI.0000000000002067.

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

Martin Muddu  1   2 , Andrew K Tusubira  2 , Srish K Sharma  3 , Ann R Akiteng  2 , Isaac Ssinabulya  1   2   4 , Jeremy I Schwartz  2   5
Affiliations

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

Martin Muddu et al. J Acquir Immune Defic Syndr. .

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.

PubMed Disclaimer

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.
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
See this image and copyright information in PMC

References

    1. El-Sadr WM, Goosby E. Building on the HIV platform: tackling the challenge of noncommunicable diseases among persons living with HIV. AIDS. 2018;32:S1–S3. - PubMed
    1. Njuguna B, Vorkoper S, Patel P et al. Models of integration of HIV and noncommunicable disease care in sub-Saharan Africa: lessons learned and evidence gaps. AIDS. 2018;32:S33–S42. - PMC - PubMed
    1. Forouzanfar MH, Afshin A, Alexander LT et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388: 1659–1724. - PMC - PubMed
    1. Haldane V, Legido-Quigley H, Chuah FLH et al. Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review. AIDS Care. 2018;103–115. - PubMed
    1. Magafu MG, Moji K, Igumbor EU et al. Non-communicable diseases in antiretroviral therapy recipients in Kagera Tanzania: a cross-sectional study. Pan Afr Med J. 2013; 16:84. - PMC - PubMed

Publication types

Substances