Improving the screening and treatment of hypertension in people living with HIV: An evidence-based policy brief by Malawi’s Knowledge Translation Platform

Mitambo, Collins; Khan, Shiraz; Matanje-Mwagomba, Beatrice; Kachimanga, Chiyembekezo; Wroe, Emily; Segula, Dalitso; Amberbir, Alemayehu; Garone, Daniela; Malík, Peter; Gondwe, Austrida; Berman, Josh

doi:10.4314/mmj.v29i2.27

Cited by 11 publications

(8 citation statements)

References 28 publications

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“…In Côte d'Ivoire, cervical cancer screening was offered to all women attending HIV services at four clinics, by means of a mobile team of midwives15. All women attending an urban HIV clinic in Botswana were offered VIA as part of the clinic's services12 and in a large HIV clinic in Lilongwe, Malawi, hypertension and cervical cancer are also screened for and managed as part of routine anti-retroviral (ART) services16.…”

Section: Introductionmentioning

confidence: 99%

Early experiences in integrating cervical cancer screening and treatment into HIV services in Zomba Central Hospital, Malawi

Pfaff

2018

Mal. Med. J

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BackgroundMalawi has the highest rate of cervical cancer globally and cervical cancer is six to eight times more common in women with HIV. HIV programmes provide an ideal setting to integrate cervical cancer screening.MethodsTisungane HIV clinic at Zomba Central Hospital has around 3,700 adult women receiving treatment. In October 2015, a model of integrated cervical cancer screening using visual inspection with acetic acid (VIA) was adopted. All women aged 20 and above in the HIV clinic were asked if they had cervical cancer screening in the past three years and, if not, were referred for screening. Screening was done daily by nurses in a room adjacent to the HIV clinic. Cold coagulation was used to treat pre-cancerous lesions. From October 2016, a modification to the HIV programme's electronic medical record was developed that assisted in matching numbers of women sent for screening with daily screening capacity and alerted providers to women with pre-cancerous lesions who missed referrals or treatment.ResultsBetween May 2016 and March 2017, cervical cancer screening was performed in 957 women from the HIV clinic. Of the 686 (71%) women who underwent first ever screening, 23 (3.4%) were found to have VIA positive lesions suggestive of pre-cancer, of whom 8 (35%) had a same-day cold coagulation procedure, seven (30%) deferred cold coagulation to a later date (of whom 4 came for treatment), and 8 (35%) were referred to surgery due to size of lesion; 5/686 (0.7%) women had lesions suspicious of cancer.ConclusionIncorporating cervical cancer screening into services at HIV clinics is feasible. A structured approach to screening in the HIV clinic was important.

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Section: Introductionmentioning

confidence: 99%

Early experiences in integrating cervical cancer screening and treatment into HIV services in Zomba Central Hospital, Malawi

Pfaff

2018

Mal. Med. J

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“…It provides the opportunity to initiate and optimize management of high BP especially among high risk groups such as ALWH. Primary HIV care provides an ideal setting for screening since patients are required to routinely attend care [ 31 , 32 ]. Using a mixed-methods approach, we evaluated implementation of BP screening within routine HIV care at three archetypal clinics run by Uganda Cares.…”

Section: Discussionmentioning

confidence: 99%

“…Both patients and providers mentioned the need for BP screening with access to treatment. BP screening with access to antihypertensive treatment has heretofore been suggested for ALWH [ 32 , 33 ]. Indeed, screening could be unavailing if patients cannot appropriately access therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, we ought to increase opportunity for screening. Whatever approach is chosen for HIV and hypertension care integration [ 32 ], increasing likelihood of screening seems to require more interaction with providers who can measure BP, even within current DSD models. There are opportunities of enhancing screening via prioritization of special populations.…”

Section: Discussionmentioning

confidence: 99%

“…Various models for integrating BP screening into HIV care have been suggested [ 30 ]. Proposals include: combination with voluntary HIV counselling and testing [ 31 ], during HIV primary care visits [ 32 , 33 ], and via community differentiated care delivery [ 32 ]. Rationale and effectiveness of these approaches are yet to be fully evaluated [ 34 ].…”

Section: Introductionmentioning

confidence: 99%

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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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Systematic Review of Hypertension and Diabetes Burden, Risk Factors, and Interventions for Prevention and Control in Malawi: The NCD BRITE Consortium

Amberbir

Lin

Berman

et al. 2019

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Recent studies have found an increasing burden of noncommunicable diseases in sub-Saharan Africa. A compressive search of PubMed, Medline, EMBASE, and the World Health Organization Global Health Library databases was undertaken to identify studies reporting on the prevalence, risk factors, and interventions for hypertension and diabetes in Malawi. The findings from 23 included studies revealed a high burden of hypertension and diabetes in Malawi, with estimates ranging from 15.8% to 32.9% and from 2.4% to 5.6%, respectively. Associated risk factors included old age, tobacco smoking, excessive alcohol consumption, obesity, physical inactivity, high salt and sugar intake, low fruit and vegetable intake, high body mass index, and high waist-to-hip ratio. Certain antiretroviral therapy regimens were also associated with increased diabetes and hypertension risk in human immunodeficiency virus patient populations. Nationwide, the quality of clinical care was generally limited and demonstrated a need for innovative and targeted interventions to prevent, control, and treat noncommunicable diseases in Malawi. Noncommunicable diseases (NCDs)-including cancer, diabetes, cardiovascular diseases, and chronic lung diseases-account for >80% of all premature NCD deaths [1]. This burden is likely to become larger over the next decade as urbanization and lifestyle changes progress and the mean age of the population increases [2]. In sub-Saharan Africa, NCDs are projected to account for almost 50% of all deaths by 2030 [3], presenting a major barrier to development [2]. NCDs and their risk factors are becoming major public health problems in Africa [4]. Recent data in Malawi show a high burden of hypertension, diabetes, and their risk factors (including tobacco, alcohol, and physical inactivity, all of which are increasing in prevalence) in both urban and rural areas [5,6]. Increasingly, hypertension and diabetes has been affecting individuals of younger ages and of relatively low or normal body mass index [5]. Complications of hypertension and diabetes, such as heart failure, stroke, myocardial infarction, hyperglycemia, and renal failure, are common reasons for admissions to medical departments in Malawi [7].

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Improving the screening and treatment of hypertension in people living with HIV: An evidence-based policy brief by Malawi’s Knowledge Translation Platform

Cited by 11 publications

References 28 publications

Early experiences in integrating cervical cancer screening and treatment into HIV services in Zomba Central Hospital, Malawi

Early experiences in integrating cervical cancer screening and treatment into HIV services in Zomba Central Hospital, Malawi

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

Systematic Review of Hypertension and Diabetes Burden, Risk Factors, and Interventions for Prevention and Control in Malawi: The NCD BRITE Consortium

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