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Integrated Hypertension and HIV Care Cascades in an HIV Treatment Program in Eastern Uganda: A Retrospective Cohort
Martin Muddu1,2, Andrew K Tusubira2, Srish K Sharma3
1Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Insights
Integrating hypertension (HTN) care into HIV programs in Uganda shows gaps in HTN management, despite successful HIV care. Focus on screening and retention for HTN is needed to improve outcomes for people living with HIV.
Area of Science:
- Public Health
- Infectious Diseases
- Cardiovascular Health
Background:
- People living with HIV (PLHIV) face higher cardiovascular disease risks.
- Integrating hypertension (HTN) services into HIV care is recommended in Uganda but has limited uptake.
- This study compares HTN and HIV care cascades within an HIV program in Eastern Uganda.
Purpose of the Study:
- To compare the care cascades for hypertension and HIV in a cohort of people living with HIV (PLHIV).
- To identify quality gaps in integrated hypertension and HIV care.
- To evaluate the impact of managing HTN on HIV care outcomes.
Main Methods:
- Retrospective cohort study of 1649 PLHIV across 3 HIV clinics (2014-2017).
- Analysis of care cascade steps (Screened, Diagnosed, Treatment Initiation, Retention, Monitoring, Control) over 12 months.
- Descriptive statistics and comparative tests (χ², t-tests) were used.
Main Results:
- The HIV care cascade showed high performance (98.5% initiated on treatment, 90.3% viral suppression).
- The hypertension care cascade had lower performance (46.9% diagnosed, 24.3% blood pressure control).
- No significant differences in HIV cascade steps were observed between PLHIV with HIV alone versus those with HIV and HTN.
Conclusions:
- The HIV care cascade is nearing global targets, while the HTN cascade reveals significant quality gaps.
- Managing hypertension did not negatively affect HIV care.
- Integration models should prioritize HTN screening, retention, and control for PLHIV to build on HIV program successes.
Background:
Persons living with HIV (PLHIV) are at increased risk of cardiovascular disease. Integration of services for hypertension (HTN), the primary cardiovascular disease risk factor, into HIV care programs is recommended in Uganda, though, uptake has been limited. We sought to compare the care cascades for HTN and HIV within an HIV program in Eastern Uganda.
Methods:
We conducted a retrospective cohort study of all PLHIV enrolled in 3 HIV clinics between 2014 and 2017. We determined the proportion of patients in the following cascade steps over 12 months: Screened, Diagnosed, Initiated on treatment, Retained, Monitored, and Controlled. Cascades were analyzed using descriptive statistics and compared using χ and t tests.
Results:
Of 1649 enrolled patients, 98.5% were initiated on HIV treatment, of whom 70.7% were retained in care, 100% had viral load monitoring, and 90.3% achieved control (viral suppression). Four hundred fifty-six (27.7%) participants were screened for HTN, of whom 46.9% were diagnosed, 88.1% were initiated on treatment, 57.3% were retained in care, 82.7% were monitored, and 24.3% achieved blood pressure control. There were no differences in any HIV cascade step between participants with HIV alone and those with both conditions.
Conclusions:
The HIV care cascade approached global targets, whereas the parallel HTN care cascade demonstrated notable quality gaps. Management of HTN within this cohort did not negatively impact HIV care. Our findings suggest that models of integration should focus on screening PLHIV for HTN and retention and control of those diagnosed to fully leverage the successes of HIV programs.
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