Implementing Screening for Hypertension in Archetypal HIV Primary Care: A Mixed-Methods Assessment

Abstract BACKGROUND: High prevalence of HIV and hypertension in sub-Saharan Africa puts HIV-infected adults are at high risk of end-organ complications. Both World Health Organization (WHO) and national guidelines recommend screening and treatment of hypertension among HIV-infected adults on antiretroviral therapy(ART). We evaluated the implementation of hypertension screening among adults on ART at three Uganda Cares Primary care facilities. METHODS: Using an explanatory mixed-methods approach we reviewed patient records, and interviewed both patients and providers during 2017 and 2018. We obtained demographics, clinical and blood pressure (BP) measurements via records review. We estimate the period prevalence of screening and use adjusted log binomial regression to evaluate for predictors of screening. In-depth interviews were analysed using a thematic approach to explain the observed prevalence and predictors of BP screening. RESULTS: Records for 1426 HIV-infected adults 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 median duration was 4 years. Only 262 (18%) were overweight or obese with a body mass index (BMI) >25 Kg/M 2 . 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 collaborated by patients’ and providers’ interviews. This was attributed to challenges that included; patient numbers, staffing, provider apathy, access to treatment, and availability and function of BP equipment. CONCLUSION: 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 addressing modifiable challenges and ensuring local buy-in beyond just providing equipment.