Characteristics and Patterns of Retention in Hypertension Care in Primary Care Settings From the Hypertension Treatment in Nigeria Program

Abstract

BACKGROUND More than 1.2 billion adults worldwide have hypertension. High retention in clinical care is essential for long-term management of hypertension, but 1-year retention rates are less than 50% in many resource-limited settings. OBJECTIVE To evaluate short-term retention rates and associated factors among patients with hypertension in primary health care centers in the Federal Capital Territory of Nigeria. DESIGN, SETTING, AND PARTICIPANTSIn this cohort study, data were collected by trained study staff from adults aged 18 years or older at 60 public, primary health care centers in Nigeria between January 2020 and July 2021 as part of the Hypertension Treatment in Nigeria (HTN) Program.Patients with hypertension were registered.EXPOSURES Follow-up visit for hypertension care within 37 days of the registration visit. MAIN OUTCOMES AND MEASURESThe main outcome was the 3-month rolling average 37-day retention rate in hypertension care, calculated by dividing the number of patients who had a follow-up visit within 37 days of their first (ie, registration) visit in the program by the total number of registered patients with hypertension during multiple consecutive 3-month periods. Interrupted time series analyses evaluated trends in retention rates before and after the intervention phase of the HTN Program. Mixed-effects, multivariable regression models evaluated associations between patient-, site-, and area council-level factors, hypertension treatment and control status, and 37-day retention rate. RESULTSIn total, 10 686 patients (68.3% female; mean [SD] age, 48.8 [12.7] years) were included in the analysis. During the study period, the 3-month rolling average 37-day retention rate was 41% (95% CI, 37%-46%), with wide variability among sites. The retention rate was higher among patients who were older (adjusted odds ratio [aOR], 1.01 per year; 95% CI, 1.01-1.02 per year), were female (aOR, 1.11; 95% CI, 1.01-1.23), had a higher body mass index (aOR, 1.01; 95% CI, 1.00-1.02), were in the Kuje vs the Abaji area council (aOR, 2.25; 95% CI, 1.25-4.04), received hypertension treatment at the registration visit (aOR, 1.27; 95% CI, 1.07-1.50), and were registered during the postintervention period (aOR, 1.16; 95% CI, 1.06-1.26). CONCLUSIONS AND RELEVANCEThe findings suggest that retention in hypertension care is suboptimal in primary health care centers in Nigeria, although large variability among sites was (continued) Key Points Question What are characteristics and patterns of retention in hypertension care in primary care settings in Nigeria? Findings In this cohort study of 10 686 patients with hypertension at 60 primary health care centers, the 3-month rolling average 37-day retention rate was 41%, with wide variability among centers. The retention rate was higher among patients who were older, were female, had a higher body mass index, lived in the Kuje area council, received hypertension treatment at the registration visit, and were registered during the postintervention period. Meaning The findings suggest t...

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