A community health worker delivered intervention to address hypertension among adults engaged in HIV care in northern Tanzania: Outcomes from a pilot feasibility study

Abstract

Current care models are inadequate to address the dual epidemic of hypertension and HIV in sub‐Saharan Africa. We developed a community health worker (CHW)‐delivered educational intervention, integrated into existing HIV care to address hypertension in persons living with HIV. A detailed educational curriculum was created with five sessions: three in‐person clinic sessions and two telephone sessions. The intervention was piloted among hypertensive adults at one HIV clinic in northern Tanzania over a 4‐week period. Primary outcomes were feasibility, fidelity, and acceptability of the intervention. Secondary outcomes included hypertension care engagement and systolic and diastolic blood pressure (SBP and DBP). Among 16 eligible participants, 14 (64% women, median age of 54.5 years) were recruited into the study, and 13 (92.9%) completed all five intervention sessions. The intervention was delivered with 98.8% fidelity to the curriculum content. Hypertension care engagement improved following the intervention. At baseline, two (15.4%) participants had seen a doctor previously for hypertension, compared to 11 (84.6%) participants post‐intervention (P = .0027). No participant was using antihypertensives at baseline, compared to 10 (76.9%) post‐intervention (P = .0016). Pre‐intervention median SBP was 164 (IQR 152–170) mmHg, compared to post‐intervention SBP of 146 (IQR 134–154) mmHg (P = .0029). Pre‐intervention median DBP was 102 (IQR 86–109) mmHg, compared to post‐intervention DBP of 89 (IQR 86–98) mmHg (P = .0023). A CHW‐delivered educational intervention, integrated into existing HIV care, is feasible and holds promise in improving hypertension care engagement and reducing blood pressure. Further research is needed to evaluate the efficacy and scale‐up of our intervention.

HIV assisted partner services (aPS) to support integrated HIV and hypertension screening in Kenya: a pre-post intervention study

“…We also observed changes in anthropometric measures at the 3-month visit with statistically significant declines in blood pressure among female index clients, though this was not observed among the male relatives. In a pilot study in Tanzania, researchers observed similar blood pressure declines over a 4-week period when utilizing a community healthcare worker delivered educational intervention to support integrated hypertension care engagement in HIV programs [ 29 ]. Such people-centered care models hold promise in improving care and management of hypertension, and potentially other NCDs, within HIV care programs.…”

A Holistic framework to integrate HIV and cardiovascular disease care in sub-saharan Africa

“…Similarly, a pilot study in Tanzania evaluated the feasibility of an educational intervention for hypertension management in PWH, which combined clinic-based and telephone-based components. The study demonstrated high levels of fidelity, improved hypertension care engagement, and high patient satisfaction, indicating that integrated HIV-CVD care leveraging telemedicine would be acceptable to both clinicians and PWH [19].…”

“…HIV-CVD integration is used as an example in this article due to the high CVD comorbidity and excess CVD-associated mortality in PWH [6,16]. Although existing models for integrated HIV-CVD care in SSA have been positively received by PWH and have shown more patient-centered care, they have focused primarily on hypertension, and have been associated with a lack of care continuity due to the absence of longitudinal support embedded within patient communities [17][18][19][20]. Moreover, these models have only been implemented on a small scale due to infrastructural limitations.…”

Hypertension in an Emergency Department Population in Moshi, Tanzania; A Qualitative Study of Barriers to Hypertension Control

“…Given physician time and resource demands in the ED, this type of intervention could be conducted by a nurse or mid-level provider [37,38]. In fact, a recent study of a hypertension intervention in the hypertensive HIV population in the Kilimanjaro region found a brief educational intervention delivered by a community health worker in the outpatient setting to be well accepted, highly feasible and potentially efficacious [39]. Two large-scale randomized, controlled trials incorporating community health workers for hypertension in Kenya found similar positive results [40,41].…”