Health services intervention integrating HTN and HIV care improves long-term blood pressure control among people living with HIV in Uganda

Abstract

Background Globally, the prevalence of hypertension (HTN) among people with HIV (PWH) has increased dramatically over the last decade. In a cluster randomized trial, we evaluated the effect of a multicomponent intervention model on blood pressure (BP) control among PWH in rural Uganda. Methods The integrated HIV/HTN trial enrolled adults (≥18-years) with HIV from 52 health centres in 26 districts of Southwestern Uganda. The intervention included: 1) health-worker training on integrating HTN care into HIV services, 2) promoting HTN screening and treatment among providers; 3) availing essential equipment and consumables; and 4) WhatsApp messaging for coordination. Among intervention participants with previously diagnosed HTN (defined as BP measurement >140/90 mmHg)), we evaluated longitudinal changes in the proportion with World Health Organization (WHO) defined control (<140/90 mmHg) from trial baseline to 12-months of follow-up. We further reported the proportions that achieved BP reduction by ≥10 mmHg. Results Of the 1200 intervention participants with HTN, 60% were female, with a median age of 49 years. At trial baseline, only 3.6% of participants had controlled BP. After 12 months of the intervention, 36.7% had achieved control, corresponding to an absolute increase of 33.1% (95%CI: 25.3–41.0%; p < 0.001). Significant improvements in BP control were observed across subgroups of age, sex and level of health centre. In addition, after 12 months, 70% of all participants had achieved at least 10 mmHg reduction in their BP, including 74% of participants with baseline Grade 2 HTN (160–179/100–109 mmHg) and 79% of participants with Grade 3 HTN (≥180/110 mmHg). Among participants without WHO-level control at 12-months, 54% achieved ≥10 mmHg reduction in BP. Conclusion This health services intervention to integrate HTN and HIV care in rural primary care facilities improved long-term BP control by 30% and most participants with baseline Grade 2 and 3 HTN achieved >10 mmHg reduction in their BP over the 12-month follow-up.