Feasibility of Community-based Hypertension Screening and Referral by Village Health Teams in Eastern Uganda: a Quasi-experimental Study

Abstract

Background Hypertension (HTN) is a significant public health challenge in Uganda, with a high prevalence and low diagnosis rate due to healthcare system deficiencies, like scarce diagnostic resources and a shortage of medical professionals. Task-shifting roles for community health workers (CHWs) could potentially fill gaps in the control of HTN, but this is still underexplored. This study determined the feasibility of leveraging CHWs, called Village Health Teams (VHTs), for HTN screening and referral in Eastern Uganda. Methods We conducted a quasi-experimental study from June to November 2023 in Jinja City and Bugembe town council, Eastern Uganda. Twelve VHTs were trained and deployed to screen and refer hypertensive patients in their communities. The training covered hypertension basics, blood pressure measurement, and referral protocols. Over four months, VHTs screened adults aged 18 and above using automatic blood pressure machines. Participants with elevated blood pressure (≥ 140/90 mmHg) on two different occasions at least 15 minutes apart were referred to a local health center for diagnosis and management. Data were collected on participant demographics, blood pressure readings, and referral outcomes and analyzed using descriptive statistics, paired t-tests, and reliability assessments in STATA version 15. A p-value < 0.05 was considered statistically significant. Results The VHTs screened 5,215 individuals, surpassing the target by 48%. The prevalence of HTN was 22.4% (n = 1167). Factors associated with HTN were older age, being male, having had previous blood pressure measurements, and alcohol use. The blood pressure measurements taken by VHTs compared to health professionals showed a high agreement (95.65%; 95% CI: 90.72% − 100%). However, of the hypertensive individuals identified, only 278 (23.8%) accepted referral to the health center. The monthly average number of new patients at the health center significantly increased from 4.6 ± 0.9 to 12.7 ± 1.4 four months before and after the intervention (t = 4.37, p = 0.0014). Conclusion VHTs can reliably screen for HTN, comparable to qualified health professionals. However, to improve the VHT-led screening and referral intervention, community trust in blood pressure measurements taken by VHTs must be enhanced to address the low referral rates.