Hypertension Care for People With HIV in Tanzania: Provider Perspectives and Opportunities for Improvement

Abstract

One in three people with HIV (PWH) has hypertension. However, most hypertensive PWH in sub-Saharan Africa are unaware of their hypertension diagnosis and are not on treatment. To better understand barriers to hypertension care faced by PWH, we interviewed 15 medical providers who care for patients with HIV and hypertension in northern Tanzania. The data revealed barriers at the patient, provider, and system level and included: stress, depression, and HIV-related stigma; lack of hypertension knowledge; insufficient hypertension training; inefficient prescribing practices; challenges with counselling; capacity limitations in hypertension care; high costs of care; and lack of routine hypertension screening and follow-up. Opportunities for improvement focused on prioritizing resources and funding towards hypertension care. System-related challenges were the underlying cause of barriers at individual levels. Strategies that focus on strengthening capacity and utilize existing HIV platforms to promote hypertension care delivery are urgently needed to improve cardiovascular outcomes among PWH.

‘My people perish for lack of knowledge’: barriers and facilitators to integrated HIV and hypertension screening at the Kenyatta National Hospital, Nairobi, Kenya

“…Participants reported low awareness of the risk factors, signs and management of hypertension similar to other studies conducted in the region2–4 18 despite large public awareness on HIV. The existing HIV infrastructure can support increased public education for hypertension and other non-communicable diseases (NCDs) at the patient, family, community and healthcare system levels, for example, through interpersonal communication between the patient and provider, community screening engagements, mass media campaigns and training of healthcare providers on screening 16.…”

“…Similar to a Tanzania study evaluating hypertension care for PLWH, providers noted system-related capacity limitations (staff, medications) and high costs of treatment as the underlying individual-level barriers and recommended prioritisation of resources and funding towards hypertension care. 18 Ongoing NHIF reforms to expand care for NCDs signal hope to patients, 22 and as policy makers consider integrated NCD management within and outside the existing HIV infrastructure, subsidies towards clinician consultation, diagnostics and medication will go a long way in improving the care cascade.…”

Hypertension and associated factors in HIV-infected patients receiving antiretroviral treatment in Burundi: a cross-sectional study

“…A study conducted in Tanzania showed barriers in integrating hypertension management for HIV control. The barriers were lack of hypertension knowledge, inefficient prescriptions, a lack of communication on related issues and hypertension care, in addition to high prices for healthcare in general, a lack of routine hypertension screening and follow-up 50 . In our study, almost 47.25% of HIV patients with hypertension were undiagnosed.…”

Six-month blood pressure and glucose control among HIV-infected adults with elevated blood pressure and hyperglycemia in northern Tanzania: A prospective observational study

“…Further study is needed to explore reasons for low uptake of these medications, since all participants were referred to an adjacent general practitioner if they were found to have elevated blood pressure or hyperglycemia at initial enrolment. Recent qualitative studies have identified multiple barriers to anti-hypertensive and anti-hyperglycemic therapies among PWH in Tanzania, including fear, lack of understanding, and cost [ 30 , 31 ]. In contrast to antiretroviral therapies, anti-hypertensive and anti-hyperglycemic medications are not provided free-of-charge in Tanzania.…”