Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries

Patel, Pragna; Rose, Charles E.; Collins, Pamela Y.; Nuche-Berenguer, Bernardo; Sahasrabuddhe, Vikrant V.; Peprah, Emmanuel; Vorkoper, Susan; Pastakia, Sonak D.; Rausch, Dianne M.; Levitt, Naomi

doi:10.1097/qad.0000000000001888

Cited by 191 publications

(144 citation statements)

References 205 publications

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“…This is incredibly concerning as both pre‐hypertension and hypertension significantly increase the risk for cardiovascular mortality 4,9 . As people with HIV continue to age, 10 and trends toward urbanization and associated unhealthy lifestyle behaviors increase in SSA, the traditional risk factors associated with prehypertension and hypertension will almost certainly rise 6 . The growing burden of pre‐hypertension, hypertension, and associated cardiovascular co‐morbidities among PLWH will be a formidable challenge in SSA if not promptly addressed.…”

Section: Discussionmentioning

confidence: 99%

“…While mortality among PLWH in SSA has declined significantly since the scale‐up of antiretroviral therapy, 5 this progress is now challenged by an increasing prevalence of non‐communicable diseases (NCDs), including hypertension and its associated cardiovascular comorbidity 6 . Failure to address hypertension may undermine the tremendous progress and efforts made toward reducing mortality among PLWH in SSA.…”

Section: Introductionmentioning

confidence: 99%

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Hypertension burden and challenges across the hypertension treatment cascade among adults enrolled in HIV care in northern Tanzania

Manavalan

Madut

Hertz

et al. 2020

J of Clinical Hypertension

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Failure to address hypertension among people living with HIV (PLWH) may undermine the significant progress made toward reducing mortality among this high‐risk population in sub‐Saharan Africa (SSA). Here, the authors report hypertension prevalence, diagnosis, and treatment among patients enrolled in HIV care in Tanzania. Patients attending an HIV clinic were consecutively screened for hypertension. Hypertension was defined as follows: a single blood pressure measurement ≥160 mm Hg systolic or ≥100 mm Hg diastolic, two measurements at separate visits ≥140 mm Hg systolic or ≥90 mm Hg diastolic, or self‐reported hypertension diagnosis. The authors screened 555 patients, and 19.6% met hypertension criteria. Among a subset of 91 hypertensive participants, 44 (48.4%) reported previous blood pressure measurements, 32 (35.2%) were aware of diagnosis, 10 (11.0%) reported current antihypertensive use, and none had controlled blood pressure. Addressing barriers along the hypertension treatment cascade must be a top priority to improve cardiovascular outcomes among PLWH in SSA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypertension burden and challenges across the hypertension treatment cascade among adults enrolled in HIV care in northern Tanzania

Manavalan

Madut

Hertz

et al. 2020

J of Clinical Hypertension

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“…Persons living with HIV (PLHIV) and receiving antiretroviral therapy (ART) are at increased risk of cardiovascular disease (CVD) [1][2][3]. In Uganda, approximately 1/3 of PLHIV aged ≥18 years have hypertension (HTN), the leading cause of CVD and preventable mortality [4][5][6][7][8][9][10][11][12]. PLHIV with HTN have an increased risk of mortality compared to HIV negative persons [13].…”

Section: Introductionmentioning

confidence: 99%

Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

Muddu

Tusubira

Nakirya

et al. 2020

Preprint

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“…Persons living with HIV (PLHIV) on antiretroviral therapy (ART) have a high prevalence of hypertension (HTN) [1][2][3]. In Uganda, approximately 1/3 of PLHIV aged ≥18 years have HTN, a leading cause of cardiovascular disease (CVD) [1,[4][5][6][7][8][9][10][11]. HTN accounts for the largest population attributable risk for myocardial infarction and end stage renal disease in PLHIV [12].…”

Section: Introductionmentioning

confidence: 99%

Hypertension Care Cascade at a Large Urban HIV Clinic in Uganda: A Mixed Methods Study Using the Capability, Opportunity, Motivation for Behavior Change (COM-B) Model

Muddu

Ssinabulya

Kigozi

et al. 2020

Preprint

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Background: Persons Living with HIV (PLHIV) receiving antiretroviral therapy (ART) have a high prevalence of hypertension (HTN) and increased risk of mortality from cardiovascular diseases. HTN and HIV care integration is recommended in Uganda, though its implementation has lagged. In this study, we sought to analyze the HTN and HIV care cascades and explore barriers and facilitators of HTN/HIV integration within a large HIV clinic in urban Uganda.Methods: We conducted an explanatory sequential mixed methods study at Mulago ISS clinic in Kampala, Uganda. We determined proportions of patients in HTN and HIV care cascade steps of: Screened, Diagnosed, Initiated on treatment, Retained, and Controlled. Guided by the Capability, Opportunity, Motivation and Behavior (COM-B) model, we then conducted semi-structured interviews and focus group discussions with healthcare providers and hypertensive PLHIV (n=45). We coded the qualitative data deductively and analyzed the data thematically categorizing them as themes that influenced HTN care positively or negatively. These denoted barriers and facilitators, respectively.Results: Of 15,953 adult PLHIV, 99.1% were initiated on ART, 89.5% were retained in care and 98.0% achieved control (viral suppression) at one year. All 15,953 (100%) participants were screened for HTN, of whom 24.3% had HTN. HTN treatment initiation, one-year retention, and control were low at 1.0%, 15.4% and 5.0%, respectively. Barriers and facilitators of HTN/HIV integration appeared in all three COM-B domains. Barriers included low patient knowledge of HTN complications, less priority by patients for HTN treatment compared to ART, sub-optimal provider knowledge of HTN treatment, lack of HTN treatment protocols, inadequate supply of anti-hypertensive medicines and lack of HTN care performance targets. Facilitators included patients’ and providers’ interest in HTN/HIV integration, patients’ interest in PLHIV peers support, providers’ knowledge and skills for HTN screening, optimal ART adherence counseling, and availability of automated BP machines. Conclusion: The prevalence of HTN among PLHIV is high, but the HTN care cascade is sub-optimal in this successful HIV clinic. To close these gaps, models of integrated HTN/HIV care are urgently needed. These findings provide a basis for designing contextually appropriate interventions for HTN/HIV integration in Uganda and other low and middle-income countries.

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Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries

Abstract: Improved data collection and surveillance of NCDs among PLHIV in LMICs are necessary to inform integrated HIV/NCD care models. Although efforts to integrate care exist, further research is needed to optimize the efficacy of these programs.

Cited by 191 publications

References 205 publications

Hypertension burden and challenges across the hypertension treatment cascade among adults enrolled in HIV care in northern Tanzania

Hypertension burden and challenges across the hypertension treatment cascade among adults enrolled in HIV care in northern Tanzania

Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)

Hypertension Care Cascade at a Large Urban HIV Clinic in Uganda: A Mixed Methods Study Using the Capability, Opportunity, Motivation for Behavior Change (COM-B) Model

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