Division of HIV, Infectious Disease, & Global Medicine, University of California, San Francisco, CA, United States of America.
Infectious Diseases Research Collaboration, Kampala, Uganda.
PLoS One. 2022 Nov 7;17(11):e0277312. doi: 10.1371/journal.pone.0277312. eCollection 2022.
Fewer than 10% of people with hypertension in sub-Saharan Africa are diagnosed, linked to care, and achieve hypertension control. We hypothesized that a one-time financial incentive and phone call reminder for missed appointments would increase linkage to hypertension care following community-based screening in rural Uganda and Kenya.
In a randomized controlled trial, we conducted community-based hypertension screening and enrolled adults ≥25 years with blood pressure ≥140/90 mmHg on three measures; we excluded participants with known hypertension or hypertensive emergency. The intervention was transportation reimbursement upon linkage (~$5 USD) and up to three reminder phone calls for those not linking within seven days. Control participants received a clinic referral only. Outcomes were linkage to hypertension care within 30 days (primary) and hypertension control <140/90 mmHg measured in all participants at 90 days (secondary). We used targeted minimum loss-based estimation to compute adjusted risk ratios (aRR).
We screened 1,998 participants, identifying 370 (18.5%) with uncontrolled hypertension and enrolling 199 (100 control, 99 intervention). Reasons for non-enrollment included prior hypertension diagnosis (n = 108) and hypertensive emergency (n = 32). Participants were 60% female, median age 56 (range 27-99); 10% were HIV-positive and 42% had baseline blood pressure ≥160/100 mmHg. Linkage to care within 30 days was 96% in intervention and 66% in control (aRR 1.45, 95%CI 1.25-1.68). Hypertension control at 90 days was 51% intervention and 41% control (aRR 1.22, 95%CI 0.92-1.66).
A one-time financial incentive and reminder call for missed visits resulted in a 30% absolute increase in linkage to hypertension care following community-based screening. Financial incentives can improve the critical step of linkage to care for people newly diagnosed with hypertension in the community.
在撒哈拉以南非洲，不到 10%的高血压患者得到诊断、与医疗服务建立联系并实现血压控制。我们假设，在乌干达和肯尼亚的农村地区，通过社区为基础的筛查，为错过预约的患者提供一次性经济激励和电话提醒，可以增加与高血压治疗的联系。
在一项随机对照试验中，我们进行了社区为基础的高血压筛查，并招募了血压≥140/90mmHg 的年龄≥25 岁的成年人，在三次测量中进行；我们排除了已知患有高血压或高血压急症的参与者。干预措施是在与高血压治疗建立联系时提供交通报销（约 5 美元），并为那些在七天内未建立联系的患者提供多达三次电话提醒。对照组仅提供诊所转诊。主要结局是在 30 天内与高血压治疗建立联系，次要结局是在 90 天内所有参与者的高血压控制情况（<140/90mmHg）。我们使用有针对性的最小损失估计法计算调整后的风险比（aRR）。
我们共筛查了 1998 名参与者，发现 370 名（18.5%）患者血压未得到控制，并招募了 199 名参与者（对照组 100 名，干预组 99 名）。未入组的原因包括先前诊断为高血压（n=108）和高血压急症（n=32）。参与者中女性占 60%，中位年龄为 56 岁（范围 27-99 岁）；10%的参与者 HIV 阳性，42%的参与者基线血压≥160/100mmHg。在干预组中，30 天内与治疗建立联系的比例为 96%，而在对照组中为 66%（aRR 1.45，95%CI 1.25-1.68）。在 90 天时，干预组的高血压控制率为 51%，对照组为 41%（aRR 1.22，95%CI 0.92-1.66）。
在社区为基础的筛查后，提供一次性经济激励和错过预约的电话提醒，使与高血压治疗建立联系的比例绝对增加了 30%。经济激励可以改善社区中新诊断为高血压患者的关键联系环节，提高他们接受治疗的机会。
