Mixed methods assessment of an integrated hypertension and HIV care model: Acceptability, feasibility, and clinical outcomes at primary healthcare clinics in Wakiso District, Uganda

Abstract

Background: The World Health Organization (WHO) recommends integrating hypertension and human immunodeficiency virus (HIV) care; however, evidence for implementing integrated care in primary healthcare (PHC) HIV clinics remains limited.
Aim: To assess the feasibility and acceptability of a pilot model for integrating hypertension care into HIV services and to describe the hypertension care cascade among people living with HIV (PLHIV) and hypertension.
Setting: Two PHC HIV clinics in Wakiso district, Uganda.
Methods: We conducted a parallel convergent mixed methods study. The pilot intervention included providing blood pressure (BP) cuffs, antihypertensive medications, a treatment algorithm and training healthcare provider (HCP) on hypertension care. Quantitative data were collected from February 2022 to December 2022. Using the consolidated framework for implementation research, we conducted interviews with HCPs (n = 12) and PLHIV with hypertension (n = 8) to explore implementation determinants. We performed descriptive analysis for hypertension care cascades. Qualitative data identified barriers and facilitators to integrating HIV and hypertension care.
Results: Of 3802 PLHIV in care, 3502 (92%) were screened for hypertension. Among these, 290 (8.3%) had a chart diagnosis of hypertension, 282 (97.2%) were treated and 128 (50.2%) achieved BP control. Key facilitators included access to medications, BP monitors and improved provider knowledge on management of BP among PLHIV. Barriers included unsynchronised clinic visits and increased provider workload.
Conclusion: Integrating hypertension and HIV services in Ugandan HIV clinics is feasible and acceptable. Availability of resources (BP medications and monitors) and trained personnel facilitates integration of these services.
Contribution: This pilot study provides evidence that integrating hypertension care into existing PHC HIV in Uganda and other similar settings is both feasible and acceptable but may necessitate additional human resources for health.