Ugandans with both HIV and high blood pressure are not getting the care they need

Research shows that HIV clinics don’t have enough resources and personnel to take care of patients who also suffer from high blood pressure.

High blood pressure, or hypertension, affects 1 in 3 adults living with HIV in Uganda. Since people suffering from these two conditions together must make regular trips to hospitals, researchers say it makes sense for existing HIV clinics to also diagnose and treat hypertension, instead of sending their hypertensive patients elsewhere. 

Unfortunately, many HIV clinics have still not successfully integrated hypertension care with the HIV care they already provide.

 Researchers investigated why integrated care works or does not work in eastern Uganda. Understanding the challenges will help to develop better ways to integrate hypertension and HIV care.

They interviewed healthcare workers in HIV clinics and patients living with both HIV and hypertension. They analysed the responses using standard scientific methods for improving healthcare interventions.

 They found  that  HIV clinics lacked skilled personnel and resources, including blood pressure machines and medications. Patients also didn’t know that they could get medical attention for both diseases at HIV clinics.

Other researchers have studied how Africa can integrate hypertension and HIV care. However, this was the first time that the standard scientific method mentioned above, known as the Consolidated Framework for Implementation Research (CFIR), was used to look at specific solutions to the problem.

The researchers cautioned however that in their study, many patients were unaware of integrated HIV-hypertension care, because they had never been introduced to it. This meant many could not properly answer the interview questions. 

They therefore recommended that future research should focus on patients’ perspectives. They also said more studies are needed to compare the costs and benefits of integrated hypertension and HIV care.

Ugandan and other African health authorities can use insights from this research to design integrated care for hypertension and HIV. With such interventions, we can eliminate avoidable deaths due to hypertension, since it will be diagnosed early and treated when patients seek care for HIV.

Abstract

Background: Persons living with HIV (PLHIV) receiving antiretroviral therapy have increased risk of cardiovascular disease (CVD). Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV clinics is recommended in Uganda. Our prior work demonstrated multiple gaps in implementation of integrated HTN care along the HIV treatment cascade. In this study, we sought to explore barriers to and facilitators of integrating HTN screening and treatment into HIV clinics in Eastern Uganda.

Methods: We conducted a qualitative study at three HIV clinics with low, intermediate, and high HTN care cascade performance, which we classified based on our prior work. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews and focus group discussions with health services managers, healthcare providers, and hypertensive PLHIV (n = 83). Interviews were transcribed verbatim. Three qualitative researchers used the deductive (CFIR-driven) method to develop relevant codes and themes. Ratings were performed to determine valence and strengths of each CFIR construct regarding influencing HTN/HIV integration.

Results: Barriers to HTN/HIV integration arose from six CFIR constructs: organizational incentives and rewards, available resources, access to knowledge and information, knowledge and beliefs about the intervention, self-efficacy, and planning. The barriers include lack of functional BP machines, inadequate supply of anti-hypertensive medicines, additional workload to providers for HTN services, PLHIV’s inadequate knowledge about HTN care, suboptimal knowledge, skills and self-efficacy of healthcare providers to screen and treat HTN, and inadequate planning for integrated HTN/HIV services. Relative advantage of offering HTN and HIV services in a one-stop centre, simplicity (non-complex nature) of HTN/ HIV integrated care, adaptability, and compatibility of HTN care with existing HIV services are the facilitators for HTN/HIV integration. The remaining CFIR constructs were non-significant regarding influencing HTN/HIV integration.

Conclusion: Using the CFIR, we have shown that while there are modifiable barriers to HTN/HIV integration, HTN/HIV integration is of interest to patients, healthcare providers, and managers. Improving access to HTN care among PLHIV will require overcoming barriers and capitalizing on facilitators using a health system strengthening approach. These findings are a springboard for designing contextually appropriate interventions for HTN/HIV integration in low- and middle-income countries.

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