Prevalence of uncontrolled hypertension and associated factors among adult HIV-infected patients on integrated HIV and hypertension care at Mulago National Referral Hospital, Uganda.

Abstract

Background: The integration of hypertension (HTN) management into HIV care is the most sustainable approach to addressing the burden of uncontrolled HTN among people living with HIV (PLHIV). However, HTN control is still suboptimal among PLHIV. Literature on factors associated with uncontrolled HTN among hypertensive PLHIV on integrated HIV/HTN care is scanty. This study sought to establish the prevalence of uncontrolled HTN and associated factors among hypertensive PLHIV in HIV/HTN integrated care. Methods: A cross-sectional design was used to study hypertensive PLHIV in integrated care at Mulago national referral hospital HIV Clinic from January 2019 to December 2021. Adult PLHIV with suppressed viral load and diagnosed with HTN were included in the study. Secondary data for hypertensive PLHIV who were in integrated care were abstracted from medical records, and primary data was collected from patients whose secondary data were abstracted. Modified Poisson regression analysis was used to determine the factors associated with uncontrolled HTN. Prevalence ratios at 95% confidence intervals were used as the measure of association. Results: Among 332 randomly selected eligible patients, 38.9% (129/332) had uncontrolled HTN. On adjusted analysis, the prevalence of uncontrolled HTN was higher among PLHIV who consumed vegetables for ˂ 4 days per week (adj. PR: 1.62; 95% CI: 1.01-2.33) and actively smoked (adj. PR: 1.64; 95% CI: 1.20-2.25) compared to PLHIV who consumed vegetables for ≥ 4 days per week, and non-active smokers respectively. Uncontrolled HTN was 49% higher among males (adj. PR: 1.49; 95% CI: 1.11-1.98) compared to females. Good adherence to HTN drugs (adj. PR: 0.70; 95% CI: 0.50-0.90), and good health literacy (adj. PR: 0.44; 95% CI: 0.30-0.64 were protective factors against uncontrolled HTN among hypertensive PLHIV in integrated HIV/HTN care. Conclusion: The results of the study suggest the need for prioritization of measures to facilitate behavior and lifestyle modification by MoH and healthcare providers to combat modifiable factors associated with uncontrolled HTN among hypertensive PLHIV.