AIDS Health Care Foundation, Kampala, Uganda.
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
BMC Health Serv Res. 2022 Aug 15;22(1):1041. doi: 10.1186/s12913-022-08362-y.
High prevalence of HIV and hypertension in sub-Saharan Africa puts adults living with HIV (ALWH) at high risk of end-organ complications. Both World Health Organization (WHO) and national guidelines recommend screening and treatment of hypertension among ALWH on antiretroviral therapy (ART). We evaluated the implementation of hypertension screening among adults on ART at three Uganda Cares Primary care facilities.
Using a sequential explanatory mixed-methods approach, we reviewed patient records, and interviewed both patients and providers during 2018 and 2019. We obtained demographics, clinical and blood pressure (BP) measurements via records review. We estimate the period prevalence of screening and use adjusted modified Poisson regression models to evaluate predictors of screening. In-depth interviews were analysed using a thematic approach to explain the observed prevalence and predictors of BP screening.
Records for 1426 ALWH were reviewed. Patients had a median age of 35 years and 65% of them were female. Most were on ART (89% on first-line) with a median duration of 4 years. Only 262 (18%) were overweight or obese with a body mass index (BMI) > 25 Kg/M. In 2017 or 2018 patients made a median of 3 visits and 783 patients had a BP recorded, hence a period prevalence 55%. Older age, male sex, more clinic visits, and clinic site were associated with screening in the adjusted analyses. Erratic BP screening was corroborated by patients' and providers' interviews. Challenges included; high patient numbers, low staffing, provider apathy, no access to treatment, and lack of functioning of BP equipment.
Almost half of regular HIV clinic attendees at these prototypical primary care HIV clinics were not screened for hypertension for a whole year. Improving BP screening requires attention to address modifiable challenges and ensure local buy-in beyond just providing equipment.
撒哈拉以南非洲地区 HIV 和高血压的高发率使接受抗逆转录病毒疗法（ART）的艾滋病毒感染者（ALWH）面临终末器官并发症的高风险。世界卫生组织（WHO）和国家指南均建议对接受 ART 的 ALWH 进行高血压筛查和治疗。我们评估了乌干达关怀（Uganda Cares）三家基层医疗保健机构内接受 ART 的成年人中高血压筛查的实施情况。
我们采用顺序解释性混合方法，在 2018 年和 2019 年期间查阅了患者记录，并对患者和医务人员进行了访谈。我们通过记录审查获取了人口统计学、临床和血压（BP）测量值。我们估计了筛查的期间患病率，并使用调整后的改良泊松回归模型评估了筛查的预测因素。我们使用主题分析法对深入访谈进行分析，以解释观察到的 BP 筛查的患病率和预测因素。
我们查阅了 1426 名 ALWH 的记录。患者的中位年龄为 35 岁，其中 65%为女性。大多数患者正在接受 ART（89%为一线治疗），中位治疗时间为 4 年。仅有 262 名（18%）超重或肥胖，体重指数（BMI）＞25 Kg/M。在 2017 年或 2018 年，患者的中位就诊次数为 3 次，783 名患者的血压记录在案，因此筛查期间的患病率为 55%。调整后的分析显示，年龄较大、男性、就诊次数较多以及就诊地点与筛查相关。患者和医务人员的访谈证实了血压筛查的不规律情况。面临的挑战包括患者人数多、人员配备不足、医务人员冷漠、无法获得治疗以及血压设备无法正常运行。
在这些典型的基层医疗保健 HIV 诊所中，将近一半的常规 HIV 门诊就诊者在整整一年中都未接受高血压筛查。改善血压筛查需要关注可改变的挑战，并确保除了提供设备之外还能获得当地的支持。
