Readiness of HIV clinics in Nakaseke District to integrate hypertension care

Abstract

Background: With the long lives made possible by the antiretroviral therapy (ART) programs globally, hypertension is on the rise among People Living with HIV (PLWH), especially in sub-Saharan Africa. Integrating hypertension into HIV programs promises opportunities for improved health outcomes. However, there is insufficient evidence on the capacity of rural Ugandan HIV primary healthcare facilities to integrate hypertension care. Objective: To assess the extent of hypertension screening among people living with HIV and the readiness of HIV clinics in Nakaseke District to integrate hypertension care. Methods: We conducted a mixed-methods cross-sectional study among nine HIV clinics (two hospitals, two Health Centre IVs, and five Health Centre IIIs). We assessed the facilities’ readiness to integrate hypertension using a modified WHO PEN tool across five domains: policy and clinical guidelines, human resources, essential medicines, basic equipment, and health information systems and records. We reviewed 411 records of PLWH using a data abstraction tool to establish the proportion of PLWH screened for hypertension. We conducted 16 in-depth interviews with PLWH and 15 key informant interviews with healthcare workers to explore facilitators and barriers to integration. Quantitative data were analyzed using STATA Version 14, while qualitative data were analyzed thematically using NVivo. Results: Readiness of HIV clinics in Nakaseke District to integrate hypertension care was low, with no facility meeting the 70% threshold. Key gaps were in medicines, equipment availability, records, and policies. Only 74.7% of PLWH had documented blood pressure screening. Screening was likely among PLWH diagnosed more than a year (aPR 1.69; 95% CI 1.15-2.49), and receiving care at a hospital (aPR 1.4; 95% CI 1.25-1.57) and less likely among PLWH on repeat visits (aPR 0.56; 95% CI 0.39-0.8), and those receiving care at health centre IVs (aPR 0.49; 95% CI 0.39-0.68). Barriers to integration were inadequate resources, a lack of capacity-building initiatives for the staff, and a varying refill and drug delivery model for hypertension. Facilitators for hypertension and HIV integration were training of the staff, support from implementing partners, and the perceived benefits of integrating care. Conclusion: HIV clinics in Nakaseke District are not ready to integrate hypertension care. They have major gaps in equipment, medicines, policies, and records. To enable integration, more attention should be paid to strengthening the information systems, workforce capacity, and providing essential equipment and hypertension medicine.