Introduction: The prevalence of hypertension (HTN) is increasing among people living with HIV (PLHIV) across sub-Saharan Africa. However, little data exist on the effectiveness of integrated HIV and HTN care delivery systems on blood pressure (BP) screening and control.
Methods: We conducted a cluster-randomized trial among PLHIV (≥18 years) to evaluate a multicomponent integrated HIV/HTN care model versus standard-of-care in 26 districts (13/arm) in Southwestern Uganda. The intervention included: 1) health worker (HW) training on integration; 2) promoting routine HTN screening and care; 3) improvement of the health management information system, 4) WhatsApp messages for data coordination among HWs. Both arms received BP machines, Non-Communicable Diseases (NCD) registers, patient cards and buffer stock HTN medicines. At baseline and annually, we randomly sampled PLHIV, reviewed their health records, administered surveys and measured BP. The primary endpoint was recent HTN screening at 24-months (BP measurement within 6 months). Secondary endpoints included change in HTN control (BP<140/90mmHg) from 12-to-24-months among intervention participants. All analyses accounted for clustering.
Findings: Between November 2020 to March 2023, we conducted three cross-sectional surveys. At baseline (n=2645), recent HTN screening was low: 1% in the intervention and 0.5% in the SOC. At 12 months (n=3142), recent HTN screening was 42% in the intervention compared with 6% in the SOC for a risk difference (RD)=36% (95%CI:26-46%; p<0.001). At 24 months (n=3603), recent HTN screening was 55% (95%CI:45-64%) higher in the intervention (77%) versus SOC (22% p<0.001). Similar effects were seen for women (RD=55%), men (RD=56%), adults aged 18-40years (RD=55%), and aged 41+years (RD=54%). In the intervention arm among persons with prior diagnosis, HTN control improved from 33% at 12-months to 57% at 24-months: difference=24% (95%CI:17-30%; p<0.001).
Interpretation: Integrated HIV/HTN care models improved HTN screening and BP control among PLHIV and presents opportunities to improve HTN care and reduce NCD related morbidity and mortality.
Funding: European and Developing Countries Clinical Trials Partnership (EDCTP) Grant Number: CSA2018HS-2518.
Declaration of Interest: No conflict of interest declared by the authors.
Ethical Approval: The trial was approved by the Ugandan National Council for Science and Technology (Ref: HS979ES), Makerere University School of Medicine Research & Ethics Committee (Ref: 2020–156) and the London School of Hygiene & Tropical Medicine Ethics Committee (Ref: 22196).