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Improved hypertension control at six months using an adapted WHO HEARTS-based implementation strategy at a large

Martin Muddu1, Fred C Semitala2, Isaac Kimera3

  • 1Makerere University Joint AIDS Program (MJAP), P.O. Box 7072, Kampala, Uganda. muddu.martin@gmail.com.

BMC Health Services Research
|May 24, 2022
PubMed

Insights

Implementing a HEARTS strategy improved hypertension control in adults living with HIV in Uganda. This integrated care approach enhanced blood pressure management without compromising HIV control.

Area of Science:

  • Public Health
  • Cardiology
  • Infectious Disease Management

Background:

  • Hypertension (HTN) is a significant comorbidity among persons living with HIV (PLHIV).
  • Effective HTN control strategies are crucial for PLHIV, who face increased cardiovascular risks.
  • Integrating HTN management into existing HIV care platforms can improve patient outcomes.

Purpose of the Study:

  • To adapt and implement the World Health Organization HEARTS strategy for HTN control in an urban Ugandan HIV clinic.
  • To evaluate the six-month impact of this integrated strategy on HTN and HIV outcomes in adult PLHIV.
  • To identify predictors of HTN control among PLHIV receiving integrated care.

Main Methods:

  • A pre-post study design was employed from October 2019 to March 2020.
  • The implementation strategy included health education, adherence support, routine screening, task shifting, evidence-based protocols, free medication, and monitoring tools.
  • A cohort of 1,015 adult PLHIV with HTN was assessed at baseline and six months.

Main Results:

  • Significant improvements in HTN outcomes were observed: mean systolic BP decreased from 154.3 to 132.3 mmHg, diastolic BP from 97.7 to 85.3 mmHg, and controlled HTN increased from 9.3% to 74.1% (all p < 0.001).
  • The HTN care cascade showed substantial improvements in treatment initiation (13.4% to 100%), retention (16.2% to 98.5%), and monitoring (16.2% to 98.5%).
  • HIV care metrics remained high (>95%), with viral suppression unchanged (98.7% to 99.2%, p = 0.712). ART duration and viral suppression predicted HTN control.

Conclusions:

  • The HEARTS-based strategy successfully integrated HTN and HIV care, leading to improved HTN outcomes while maintaining HIV control in a large urban clinic.
  • This approach demonstrates the feasibility of enhancing cardiovascular health management within HIV service delivery platforms.
  • Further research is warranted to explore HTN/HIV integration in diverse settings and populations.
Abstract

Keywords:
Integrated care for hypertension and HIVUsing an adapted WHO HEARTS strategy

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