Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.
JAMA Netw Open. 2022 Sep 1;5(9):e2230025. doi: 10.1001/jamanetworkopen.2022.30025.
More than 1.2 billion adults worldwide have hypertension. High retention in clinical care is essential for long-term management of hypertension, but 1-year retention rates are less than 50% in many resource-limited settings.
To evaluate short-term retention rates and associated factors among patients with hypertension in primary health care centers in the Federal Capital Territory of Nigeria.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, data were collected by trained study staff from adults aged 18 years or older at 60 public, primary health care centers in Nigeria between January 2020 and July 2021 as part of the Hypertension Treatment in Nigeria (HTN) Program. Patients with hypertension were registered.
Follow-up visit for hypertension care within 37 days of the registration visit.
The main outcome was the 3-month rolling average 37-day retention rate in hypertension care, calculated by dividing the number of patients who had a follow-up visit within 37 days of their first (ie, registration) visit in the program by the total number of registered patients with hypertension during multiple consecutive 3-month periods. Interrupted time series analyses evaluated trends in retention rates before and after the intervention phase of the HTN Program. Mixed-effects, multivariable regression models evaluated associations between patient-, site-, and area council-level factors, hypertension treatment and control status, and 37-day retention rate.
In total, 10 686 patients (68.3% female; mean [SD] age, 48.8 [12.7] years) were included in the analysis. During the study period, the 3-month rolling average 37-day retention rate was 41% (95% CI, 37%-46%), with wide variability among sites. The retention rate was higher among patients who were older (adjusted odds ratio [aOR], 1.01 per year; 95% CI, 1.01-1.02 per year), were female (aOR, 1.11; 95% CI, 1.01-1.23), had a higher body mass index (aOR, 1.01; 95% CI, 1.00-1.02), were in the Kuje vs the Abaji area council (aOR, 2.25; 95% CI, 1.25-4.04), received hypertension treatment at the registration visit (aOR, 1.27; 95% CI, 1.07-1.50), and were registered during the postintervention period (aOR, 1.16; 95% CI, 1.06-1.26).
The findings suggest that retention in hypertension care is suboptimal in primary health care centers in Nigeria, although large variability among sites was found. Potentially modifiable and nonmodifiable factors associated with retention were identified and may inform multilevel, contextualized implementation strategies to improve retention.
全球有超过 12 亿成年人患有高血压。在资源有限的环境中，高血压的长期管理需要高度的临床护理保留率，但许多情况下，1 年保留率不到 50%。
评估尼日利亚联邦首都辖区初级保健中心高血压患者的短期保留率及其相关因素。
设计、地点和参与者：在这项队列研究中，数据由经过培训的研究人员于 2020 年 1 月至 2021 年 7 月在尼日利亚的 60 个公共初级保健中心从 18 岁及以上的成年人中收集，这是尼日利亚高血压治疗（HTN）计划的一部分。登记患有高血压的患者。
在登记就诊后 37 天内进行高血压护理的随访就诊。
主要结果是高血压护理中 3 个月滚动平均 37 天保留率，通过将在该计划中首次（即登记）就诊后 37 天内进行随访就诊的患者数量除以连续多个 3 个月期间登记的高血压患者总数来计算。中断时间序列分析评估了 HTN 计划干预阶段前后保留率的趋势。混合效应多变量回归模型评估了患者、地点和地区议会级别的因素、高血压治疗和控制状况与 37 天保留率之间的关联。
共有 10686 名患者（68.3%为女性；平均[SD]年龄，48.8[12.7]岁）纳入分析。在研究期间，3 个月滚动平均 37 天保留率为 41%（95%CI，37%-46%），各地点之间差异较大。年龄较大（调整后优势比[OR]，每年增加 1.01；95%CI，每年增加 1.01-1.02）、女性（OR，1.11；95%CI，1.01-1.23）、身体质量指数较高（OR，1.01；95%CI，1.00-1.02）、在 Kuje 与 Abaji 地区议会（OR，2.25；95%CI，1.25-4.04）的患者、在登记就诊时接受高血压治疗（OR，1.27；95%CI，1.07-1.50）和在干预后期间登记（OR，1.16；95%CI，1.06-1.26）的患者保留率较高。
研究结果表明，尼日利亚初级保健中心的高血压护理保留率不理想，但各地点之间存在较大差异。确定了与保留率相关的潜在可改变和不可改变因素，这些因素可能为改善保留率提供多层次、背景化的实施策略。
