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. 2022 Aug 15;22(1):1041.
doi: 10.1186/s12913-022-08362-y.

Implementing screening for hypertension in archetypal HIV primary care: a mixed-methods assessment

Lydia Buzaalirwa  1 , Lydia Nambala  2 , Grace Banturaki  2 , Penninah Iutung Amor  1 , Anne Katahoire  3 , Elvin Geng  4 , Aggrey Semeere  5
Affiliations

Implementing screening for hypertension in archetypal HIV primary care: a mixed-methods assessment

Lydia Buzaalirwa et al. BMC Health Serv Res. .

Abstract

Background: High prevalence of HIV and hypertension in sub-Saharan Africa puts adults living with HIV (ALWH) at high risk of end-organ complications. Both World Health Organization (WHO) and national guidelines recommend screening and treatment of hypertension among ALWH on antiretroviral therapy (ART). We evaluated the implementation of hypertension screening among adults on ART at three Uganda Cares Primary care facilities.

Methods: Using a sequential explanatory mixed-methods approach, we reviewed patient records, and interviewed both patients and providers during 2018 and 2019. We obtained demographics, clinical and blood pressure (BP) measurements via records review. We estimate the period prevalence of screening and use adjusted modified Poisson regression models to evaluate predictors of screening. In-depth interviews were analysed using a thematic approach to explain the observed prevalence and predictors of BP screening.

Results: Records for 1426 ALWH were reviewed. Patients had a median age of 35 years and 65% of them were female. Most were on ART (89% on first-line) with a median duration of 4 years. Only 262 (18%) were overweight or obese with a body mass index (BMI) > 25 Kg/M2. In 2017 or 2018 patients made a median of 3 visits and 783 patients had a BP recorded, hence a period prevalence 55%. Older age, male sex, more clinic visits, and clinic site were associated with screening in the adjusted analyses. Erratic BP screening was corroborated by patients' and providers' interviews. Challenges included; high patient numbers, low staffing, provider apathy, no access to treatment, and lack of functioning of BP equipment.

Conclusion: Almost half of regular HIV clinic attendees at these prototypical primary care HIV clinics were not screened for hypertension for a whole year. Improving BP screening requires attention to address modifiable challenges and ensure local buy-in beyond just providing equipment.

Keywords: East Africa; HIV primary care; HIV-infection; Hypertension screening; Implementation; Sub-Saharan Africa; Uganda.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A flow diagram summarizing sampling from the HIV clinics and enrollment into the study
Fig. 2
Fig. 2
A casual logic model summarizing the relationship between the factors influencing blood pressure screening at the study facilities. From our qualitative and quantitative findings, we hypothesize that the key influences of blood pressure screening operate mainly via: provider and patient motivation, opportunity to measure blood pressure and the organization (institutional) capacity
See this image and copyright information in PMC

References

    1. Organization WH . A global brief on hypertension : silent killer, global public health crisis: world health day 2013. Geneva: World Health Organisation; 2013.
    1. Nduka CU, Stranges S, Sarki AM, Kimani PK, Uthman OA. Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy: a systematic review with meta-analysis. J Hum Hypertens. 2016;30(6):355–362. doi: 10.1038/jhh.2015.97. - DOI - PubMed
    1. Chow FC, Regan S, Feske S, Meigs JB, Grinspoon SK, Triant VA. Comparison of ischemic stroke incidence in HIV-infected and non-HIV-infected patients in a US health care system. J Acquir Immune Defic Syndr. 2012;60(4):351–358. doi: 10.1097/QAI.0b013e31825c7f24. - DOI - PMC - PubMed
    1. Freiberg MS, Chang CC, Kuller LH, Skanderson M, Lowy E, Kraemer KL, Butt AA, Bidwell Goetz M, Leaf D, Oursler KA, Rimland D, Rodriguez Barradas M, Brown S, Gibert C, McGinnis K, Crothers K, Sico J, Crane H, Warner A, Gottlieb S, Gottdiener J, Tracy RP, Budoff M, Watson C, Armah KA, Doebler D, Bryant K, Justice AC. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med. 2013;173(8):614–622. doi: 10.1001/jamainternmed.2013.3728. - DOI - PMC - PubMed
    1. Islam FM, Wu J, Jansson J, Wilson DP. Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta-analysis. HIV Med. 2012;13(8):453–468. - PubMed