Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States of America.
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, United States of America.
PLoS One. 2020 Dec 3;15(12):e0243059. doi: 10.1371/journal.pone.0243059. eCollection 2020.
Hypertension, a leading risk for cardiovascular mortality, is an important co-morbidity among people living with HIV (PLHIV). In Tanzania, hypertension prevalence among PLHIV approaches 20 to 30%. However, most patients are unaware of their diagnosis and are not receiving treatment. Understanding the barriers to hypertension care is a critical first step in developing interventions to improve cardiovascular outcomes among PLHIV in Tanzania and similar settings.
Between September 1st and November 26th, 2018 thirteen semi structured in-depth interviews were conducted with hypertensive patients engaged in HIV care in two HIV clinics located in government health facilities in northern Tanzania. Interviews were audio-recorded, translated into English, transcribed and thematically coded using NVivo. Data analysis was conducted using applied thematic analysis.
Participants had a median age of 54 (IQR 41-65) years. Of the 13 participants, eight stated they had used antihypertensive medication previously, but only one participant described current use of antihypertensive therapy. All participants were currently using antiretroviral therapy. The data revealed a range of themes including limited hypertension knowledge. Universally, all participants believed that "thinking too much", i.e. stress, was the major contributor to hypertension and that by "reducing thoughts", one may control hypertension. Additional emerging themes included a perceived overlap between hypertension and HIV, delays in hypertension diagnosis and linkage to care, challenges with provider communication and counseling, reluctance towards antihypertensive medication, lack of integration of hypertension and HIV care, and additional structural barriers to hypertension care.
Participants described multiple, intersecting challenges related to hypertension management. Barriers specific to PLHIV included siloed care, HIV-related stigma, and burden from multiple medical conditions. Multifaceted strategies that seek to address structural barriers, hypertension education, psychosocial stressors and stigma, and that are integrated within HIV care are urgently needed to improve cardiovascular outcomes among PLHIV in sub-Saharan Africa.
高血压是心血管死亡率的主要危险因素，也是艾滋病毒感染者（PLHIV）的重要合并症。在坦桑尼亚，PLHIV 中的高血压患病率接近 20%至 30%。然而，大多数患者并不知道自己的诊断，也未接受治疗。了解高血压护理的障碍是在坦桑尼亚和类似环境中改善 PLHIV 心血管结局的干预措施的关键第一步。
2018 年 9 月 1 日至 11 月 26 日，在坦桑尼亚北部政府卫生设施的两家 HIV 诊所中，对接受 HIV 护理的高血压患者进行了 13 次半结构式深入访谈。访谈进行了录音，翻译成英文，转录并使用 NVivo 进行主题编码。使用应用主题分析进行数据分析。
参与者的中位年龄为 54（IQR 41-65）岁。在 13 名参与者中，有 8 名表示之前曾使用过降压药，但只有 1 名参与者描述了目前使用降压治疗的情况。所有参与者目前都在使用抗逆转录病毒疗法。研究结果揭示了一系列主题，包括对高血压知识的了解有限。所有参与者普遍认为，“想太多”，即压力，是高血压的主要原因，通过“减少思考”，可以控制高血压。新出现的主题还包括高血压和 HIV 之间的感知重叠，高血压诊断和护理的延迟，与提供者沟通和咨询的挑战，对降压药物的抵触，高血压和 HIV 护理的整合不足以及高血压护理的其他结构性障碍。
参与者描述了与高血压管理相关的多种相互关联的挑战。PLHIV 特有的障碍包括孤立的护理，HIV 相关的耻辱感以及多种医疗条件带来的负担。迫切需要采取多方面的策略来解决结构性障碍，高血压教育，心理社会压力源和耻辱感，并将其整合到 HIV 护理中，以改善撒哈拉以南非洲的 PLHIV 的心血管结局。
