Low levels of hypertension screening in HIV care clinics in rural Uganda: A mixed methods study

Abstract

Background The prevalence of hypertension among people living with HIV (PLHIV) has increased over the last decade globally. Given the dual burden of disease and significant prior investment in HIV care, integrating care for hypertension and HIV is recommended. However, data on hypertension screening, treatment, and control before such integration are lacking. Using a mixed-methods approach, we assessed the baseline status of hypertension screening, treatment, and control in 52 Ugandan public health facilities, participating in an ongoing cluster randomised trial of an integrated HIV/HTN care model. Methods From November 2020 to March 2021, we reviewed patient records and randomly sampled 50 PLHIV without a documented hypertension diagnosis per health facility and all PLHIV with a documented hypertension diagnosis per health facility. We surveyed the sampled participants, measured their blood pressure, and described the hypertension care cascade. We also conducted in-depth interviews with 24 patients and 12 providers to explore their experience with hypertension screening and care. We used an in-depth thematic approach to analyze the resulting qualitative data. Results Among 2,645 PLHIV, <1% (20/2,645) had their BP measured within 6 months before the survey. The prevalence of hypertension was 13.6% (359/2,645), including 278 (10.5%) new diagnoses and 32 (1.2%) prior diagnoses that were not documented in their health record. Of 49 with a previously documented hypertension diagnosis, 31 (63.3%) were on hypertension treatment, and 53.1% had controlled hypertension. In-depth interviews with providers and patients revealed a lack of blood pressure equipment, high patient load, limited technical hypertension knowledge, and patients' fear of anticipated long waiting times as reasons for low hypertension screening in the HIV clinics. Conclusion Regular screening for the detection of hypertension patients was hardly performed. There is an urgent need for interventions to advance the integration of hypertension care in HIV clinics.