Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
BMJ Open. 2020 Nov 3;10(11):e037580. doi: 10.1136/bmjopen-2020-037580.
In 2011, The National Department of Health introduced the Integrated Chronic Disease Management (ICDM) model as a pilot programme in selected primary healthcare facilities in South Africa. The objective of this study was to determine individual-level and facility-level predictors of controlled CD4 count and blood pressure (BP) in patients receiving treatment for HIV and hypertension, respectively.
A panel study.
This study was conducted in the Bushbuckridge Municipality, South Africa from 2011 to 2013. Facility records of patients aged ≥18 years were retrieved from the integrated chronic disease management (ICDM) pilot (n=435) and comparison facilities (n=443) using a three-step probability sampling process. CD4 count and BP control are defined as CD4 count >350 cells/mm and BP <140/90 mm Hg. A multilevel Least Absolute Shrinkage and Selection Operator binary logistic regression analysis was done at a 5% significance level using STATA V.16.
CD4 (cells/mm) count and BP (mm Hg).
Compared with the comparison facilities, patients receiving treatment in the pilot facilities had increased odds of controlling their CD4 count (OR=5.84, 95% CI 3.21-8.22) and BP (OR=1.22, 95% CI 1.04-2.14). Patients aged 50-59 (OR=6.12, 95% CI 2.14-7.21) and ≥60 (OR=7.59, 95% CI 4.75-11.82) years had increased odds of controlling their CD4 counts compared with those aged 18-29 years. Likewise, patients aged 40-49 (OR=5.73, 95% CI 1.98-8.43), 50-59 (OR=7.28, 95% CI 4.33-9.27) and ≥60 (OR=9.31, 95% CI 5.12-13.68) years had increased odds of controlling their BP. In contrast, men had decreased odds of controlling their CD4 count (OR=0.12, 95% CI 0.10-0.46) and BP (OR=0.21, 95% CI 0.19-0.47) than women.
The ICDM model had a small but significant effect on BP control, hence, the need to more effectively leverage the HIV programme for optimal BP control in the setting.
2011 年，国家卫生部在南非选定的基层医疗机构推出综合慢性病管理（ICDM）模式作为试点项目。本研究旨在确定接受艾滋病毒和高血压治疗的患者的 CD4 计数和血压（BP）控制的个体和设施水平预测因素。
面板研究。
本研究于 2011 年至 2013 年在南非 Bushbuckridge 市进行。使用三步概率抽样过程从综合慢性病管理（ICDM）试点（n=435）和比较设施（n=443）中检索≥18 岁患者的设施记录。CD4 计数和 BP 控制定义为 CD4 计数>350 个细胞/mm3 和 BP<140/90mmHg。使用 STATA V.16 在 5%的显著水平上进行了最小绝对收缩和选择算子二元逻辑回归分析。
CD4（细胞/mm3）计数和 BP（mmHg）。
与比较设施相比，在试点设施接受治疗的患者控制 CD4 计数（OR=5.84，95%CI 3.21-8.22）和 BP（OR=1.22，95%CI 1.04-2.14）的可能性增加。与 18-29 岁的患者相比，50-59 岁（OR=6.12，95%CI 2.14-7.21）和≥60 岁（OR=7.59，95%CI 4.75-11.82）的患者控制 CD4 计数的可能性增加。同样，40-49 岁（OR=5.73，95%CI 1.98-8.43）、50-59 岁（OR=7.28，95%CI 4.33-9.27）和≥60 岁（OR=9.31，95%CI 5.12-13.68）的患者控制血压的可能性增加。相比之下，男性控制 CD4 计数（OR=0.12，95%CI 0.10-0.46）和 BP（OR=0.21，95%CI 0.19-0.47）的可能性低于女性。
ICDM 模式对 BP 控制有较小但有意义的影响，因此需要更有效地利用艾滋病毒计划，以在该环境中实现最佳的 BP 控制。
