Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation

Heller, David J.; Balzer, Laura B.; Kazi, Dhruv S.; Charlebois, Edwin D.; Kwarisiima, Dalsone; Mwangwa, Florence; Jain, Vivek; Kotwani, Prashant; Chamie, Gabriel; Cohen, Craig R.; Clark, Tamara D.; Ayieko, James; Byonanabye, Dathan M; Petersen, Maya; Kamya, Moses R.; Havlir, Diane V.; Kahn, James G.

doi:10.1371/journal.pone.0222801

Cited by 17 publications

(18 citation statements)

References 36 publications

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“…Among these ALWH on ART, just over a half of them (55%) were screened for hypertension at a clinic visit made in the prior year (2017 or 2018). This screening frequency was higher than findings from a clinical trial among ALWH in Eastern Uganda [36], which reported a lower (28%) prevalence of screening between 2014 and 2017 [37]. We also observed wide variation in BP screening prevalence between the three facilities in our study ((4 to 67%), Table 2).…”

Section: Discussioncontrasting

confidence: 74%

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

Buzaalirwa¹,

Nambala

Banturaki

et al. 2022

BMC Health Serv Res

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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.

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Section: Discussioncontrasting

confidence: 74%

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

Buzaalirwa¹,

Nambala

Banturaki

et al. 2022

BMC Health Serv Res

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“…Despite the challenges associated with shifting to integrated services, the Ugandan and Kenyan SEARCH (Sustainable East Africa Research in Community Health) trial demonstrates how quickly NCD care can be integrated within HIV services with community and health system mobilization [105,106]. In the SEARCH study, HIV treatment as prevention was integrated with diabetes and hypertension screening and management in rural communities with some success in hypertension control [44] However, SEARCH faced challenges in linking and retaining screened patients in care, raising questions regarding the long-term feasibility, scalability, and sustainability of this grant-funded approach, requiring additional implementation studies [105]. Many HIV services in other settings have already made the transition to broad-based NCD care and are actively working to engage the whole patient population in addition to the PLHIV they originally served [107,108].…”

Section: Discussionmentioning

confidence: 99%

Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa

Brault

Vermund

Aliyu

et al. 2021

IJERPH

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In Sub-Saharan Africa, communicable and other tropical infectious diseases remain major challenges apart from the continuing HIV/AIDS epidemic. Recognition and prevalence of non-communicable diseases have risen throughout Africa, and the reimagining of healthcare delivery is needed to support communities coping with not only with HIV, tuberculosis, and COVID-19, but also cancer, cardiovascular disease, diabetes, and depression. Many non-communicable diseases can be prevented or treated with low-cost interventions, yet implementation of such care has been limited in the region. In this Perspective piece, we argue that deployment of an integrated service delivery model is an urgent next step, propose a South African model for integration, and conclude with recommendations for next steps in research and implementation. An approach that is inspired by South African experience would build on existing HIV-focused infrastructure that has been developed by Ministries of Health with strong support from the U.S. President’s Emergency Response for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. An integrated chronic healthcare model holds promise to sustainably deliver infectious disease and non-communicable disease care. Integrated care will be especially critical as health systems seek to cope with the unprecedented challenges associated with COVID-19 and future pandemic threats.

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“…While different integration formats are yet to be evaluated in SSA, participants in Tanzania felt that a peer support system supporting at-risk group members to change risky behaviours and maintain healthy lifestyle behaviours would help improve care and treatment, similar to feedback from our FGDs 15. At the healthcare system level, participants advocated for the modified aPS model as it offered a patient-centred approach to managing HIV and hypertension 16 17. The availability of a healthcare personnel familiar with the patient’s case was seen as a major advantage, and participants felt that it was easier to receive ongoing support for care retention.…”

Section: Discussionmentioning

confidence: 91%

‘My people perish for lack of knowledge’: barriers and facilitators to integrated HIV and hypertension screening at the Kenyatta National Hospital, Nairobi, Kenya

Wamuti

Owuor²,

Magambo

et al. 2023

Open Heart

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IntroductionHIV and cardiovascular disease (CVD) are the two main causes of death in Kenya with hypertension as CVD’s leading risk factor and HIV infection a risk factor for hypertension. We qualitatively evaluated the feasibility of integrated HIV and hypertension screening at Kenyatta National Hospital.MethodsWe conducted two focus group discussions (FGDs) in November 2020 (female FGD: n=7; male FGD: n=8) to elicit facilitators, barriers and viability of integrated diagnosis and management of both conditions at HIV testing service (HTS) facilities. Participants were selected using convenience sampling and were not pair matched. All participants had received HTS. All female clients had confirmed hypertension, while male relatives had been contacted for HIV and hypertension screening through a modified assisted partner services model—where a trained healthcare provider supports notification. Transcripts were coded independently, and the codebook was developed and revised through consensus discussion. Data were analysed using thematic content analysis.ResultsMain barriers to diagnosis and management included limited public awareness of hypertension risk factors and on improved treatment outcomes for those on lifelong HIV treatment, high cost of hypertension care despite free HIV care and healthcare system challenges especially medication stockouts. Strong support systems at family and healthcare levels facilitated care and treatment for both conditions. Participants recommended improved public awareness through individual-level communication and mass media campaigns, decentralised screening services for both HIV and hypertension, and either free or subsidised hypertension care services delivered alongside HIV treatment services. Most felt that an integrated HIV and hypertension service model was viable and would improve healthcare outcomes.ConclusionPatient-centred care models combining HIV and hypertension services hold promise for integrated service delivery.

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Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation

Cited by 17 publications

References 36 publications

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

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

Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa

‘My people perish for lack of knowledge’: barriers and facilitators to integrated HIV and hypertension screening at the Kenyatta National Hospital, Nairobi, Kenya

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