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
. 2022 May 25;22(1):699.
doi: 10.1186/s12913-022-08045-8.

Improved hypertension control at six months using an adapted WHO HEARTS-based implementation strategy at a large urban HIV clinic in Uganda

Martin Muddu  1 , Fred C Semitala  2 , Isaac Kimera  3 , Mary Mbuliro  3 , Rebecca Ssennyonjo  3 , Simon P Kigozi  4 , Rodgers Katwesigye  3 , Florence Ayebare  2 , Christabellah Namugenyi  3 , Frank Mugabe  5 , Gerald Mutungi  5 , Chris T Longenecker  6 , Anne R Katahoire  2 , Isaac Ssinabulya  7 , Jeremy I Schwartz  8
Affiliations

Improved hypertension control at six months using an adapted WHO HEARTS-based implementation strategy at a large urban HIV clinic in Uganda

Martin Muddu et al. BMC Health Serv Res. .

Abstract

Objectives: To adapt a World Health Organization HEARTS-based implementation strategy for hypertension (HTN) control at a large urban HIV clinic in Uganda and determine six-month HTN and HIV outcomes among a cohort of adult persons living with HIV (PLHIV).

Methods: Our implementation strategy included six elements: health education, medication adherence, and lifestyle counseling; routine HTN screening; task shifting of HTN treatment; evidence-based HTN treatment protocol; consistent supply of HTN medicines free to patients; and inclusion of HTN-specific monitoring and evaluation tools. We conducted a pre-post study from October 2019 to March 2020 to determine the effect of this strategy on HTN and HIV outcomes at baseline and six months. Our cohort comprised adult PLHIV diagnosed with HTN who made at least one clinic visit within two months prior to study onset.

Findings: We enrolled 1,015 hypertensive PLHIV. The mean age was 50.1 ± 9.5 years and 62.6% were female. HTN outcomes improved between baseline and six months: mean systolic BP (154.3 ± 20.0 to 132.3 ± 13.8 mmHg, p < 0.001); mean diastolic BP (97.7 ± 13.1 to 85.3 ± 9.5 mmHg, p < 0.001) and proportion of patients with controlled HTN (9.3% to 74.1%, p < 0.001). The HTN care cascade also improved: treatment initiation (13.4% to 100%), retention in care (16.2% to 98.5%), monitoring (16.2% to 98.5%), and BP control among those initiated on HTN treatment (2.2% to 75.2%). HIV cascade steps remained high (> 95% at baseline and six months) and viral suppression was unchanged (98.7% to 99.2%, p = 0.712). Taking ART for more than two years and HIV viral suppression were independent predictors of HTN control at six months.

Conclusions: A HEARTS-based implementation strategy at a large, urban HIV center facilitates integration of HTN and HIV care and improves HTN outcomes while sustaining HIV control. Further implementation research is needed to study HTN/HIV integration in varied clinical settings among diverse populations.

Keywords: Integrated care for hypertension and HIV; Using an adapted WHO HEARTS strategy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no relevant competing interests.

Figures

Fig. 1
Fig. 1
The hypertension management protocol at MJAP
Fig. 2
Fig. 2
Flow chart of patient enrolment into integrated HTN/HIV Care
Fig. 3
Fig. 3
Percentage of patients enrolled in integrated HTN/HIV care with controlled BP (N = 1015)
Fig. 4
Fig. 4
HTN and HIV care cascades at baseline (A) and six months (B)
See this image and copyright information in PMC

References

    1. Pangmekeh PJ, Awolu MM, Gustave S, Gladys T, Cumber SNJTPAMJ. Association between highly active antiretroviral therapy (HAART) and hypertension in persons living with HIV/AIDS at the Bamenda regional hospital, Cameroon. Pan Afr Med J. 2019;33:87. doi: 10.11604/pamj.2019.33.87.15574. - DOI - PMC - PubMed
    1. Coetzee L, Bogler L, De Neve JW, Bärnighausen T, Geldsetzer P, Vollmer SJJotIAS. HIV, antiretroviral therapy and non‐communicable diseases in sub‐Saharan Africa: empirical evidence from 44 countries over the period 2000 to 2016. J Int AIDS Soc. 2019;22(7):e25364. doi: 10.1002/jia2.25364. - DOI - PMC - PubMed
    1. Osetinsky B, Hontelez JAC, Lurie MN, McGarvey ST, Bloomfield GS, Pastakia SD, et al. Epidemiological and health systems implications of evolving HIV and hypertension in South Africa and Kenya. Health Aff (Millwood) 2019;38(7):1173–1181. doi: 10.1377/hlthaff.2018.05287. - DOI - PMC - PubMed
    1. Kwarisiima D, Atukunda M, Owaraganise A, Chamie G, Clark T, Kabami J, et al. Hypertension control in integrated HIV and chronic disease clinics in Uganda in the SEARCH study. BMC Public Health. 2019;19(1):511. doi: 10.1186/s12889-019-6838-6. - DOI - PMC - PubMed
    1. Mutemwa M, Peer N, de Villiers A, Mukasa B, Matsha TE, Mills EJ, et al. Prevalence, detection, treatment, and control of hypertension in human immunodeficiency virus (HIV)-infected patients attending HIV clinics in the Western Cape Province, South Africa. Medicine (Baltimore) 2018;97(35):e12121. doi: 10.1097/MD.0000000000012121. - DOI - PMC - PubMed