Integrated multi-month dispensing of antihypertensive and antiretroviral therapy to sustain hypertension and HIV control

Kimera, Isaac; Namugenyi, Christabellah; Schwartz, Jeremy I.; Musimbaggo, Douglas Joseph; Ssenyonjo, Rebecca; Atukunda, Praise; Mutungi, Gerald; Mugabe, Frank; Ambangira, Fortunate; Mbuliro, Mary; Katwesigye, Rodgers; Neupane, Dinesh; Ssinabulya, Isaac; Semitala, Fred C.; Delles, Christian; Martín, Miguel

doi:10.1038/s41371-022-00655-3

Cited by 13 publications

(11 citation statements)

References 26 publications

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“…These findings guide potential interventions as increasing the amount of medicines dispensed to respondents, which was previously shown to be significantly preferred for individuals with HIV, may be less desirable for NCD management 11. Being able to consistently dispense 1 month’s worth or more of medicine, such as through differentiated service delivery models, is likely to be more effective in improving respondents’ experience managing their NCDs 36…”

Section: Discussionmentioning

confidence: 61%

“…11 Being able to consistently dispense 1 month's worth or more of medicine, such as through differentiated service delivery models, is likely to be more effective in improving respondents' experience managing their NCDs. 36 It might be expected based on prior research in other conditions/settings that respondents would prefer to travel the least distance/time possible to receive care. In our study, the relationship between the strength of preference and distance differed based on model specification.…”

Section: Discussionmentioning

confidence: 99%

“… 11 Being able to consistently dispense 1 month’s worth or more of medicine, such as through differentiated service delivery models, is likely to be more effective in improving respondents’ experience managing their NCDs. 36 …”

Section: Discussionmentioning

confidence: 99%

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Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment

et al. 2022

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ObjectiveTo explore how respondents with common chronic conditions—hypertension (HTN) and diabetes mellitus (DM)—make healthcare-seeking decisions.SettingThree health facilities in Nakaseke District, Uganda.DesignDiscrete choice experiment (DCE).Participants496 adults with HTN and/or DM.Main outcome measuresWillingness to pay for changes in DCE attributes: getting to the facility, interactions with healthcare providers, availability of medicines for condition, patient peer-support groups; and education at the facility.ResultsRespondents were willing to pay more to attend facilities that offer peer-support groups, friendly healthcare providers with low staff turnover and greater availabilities of medicines. Specifically, we found the average respondent was willing to pay an additional 77 121 Ugandan shillings (UGX) for facilities with peer-support groups over facilities with none; and 49 282 UGX for 1 month of medicine over none, all other things being equal. However, respondents would have to compensated to accept facilities that were further away or offered health education. Specifically, the average respondent would have to be paid 3929 UGX to be willing to accept each additional kilometre they would have to travel to the facilities, all other things being equal. Similarly, the average respondent would have to be paid 60 402 UGX to accept facilities with some health education, all other things being equal.ConclusionsOur findings revealed significant preferences for health facilities based on the availability of medicines, costs of treatment and interactions with healthcare providers. Understanding patient preferences can inform intervention design to optimise healthcare service delivery for patients with HTN and DM in rural Uganda and other low-resource settings.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment

et al. 2022

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“…An integrated primary care model for conditions like hypertension is possible in countries like Zambia and can improve patient outcomes (32,33). With integration, multi-month dispensing is a promising approach for comanagement of HIV and hypertension (43). Routinely monitoring for hypertension, along with documenting other health measures (e.g., diet, smoking status, BMI) in the EHR would not only allow medical providers to determine client's cardiovascular risk for CVAs or other cardiovascular events and target treatment, but also might provide data needed to identify specific health facilities or clinicians that would benefit from educational interventions in management of these risk factors and conditions.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hypertension among persons living with HIV — Zambia, 2021; A cross-sectional study of a national electronic health record system

Hines¹,

Prieto

Itoh³

et al. 2023

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Background Hypertension is a major risk factor for cardiovascular disease, which is a common cause of death in Zambia. Data on hypertension prevalence in Zambia are scarce and limited to specific geographic areas and/or populations. We measured hypertension prevalence among persons living with HIV (PLHIV) in Zambia using a national electronic health record (EHR) system. Methods We did a cross-sectional study of hypertension prevalence among PLHIV aged >=18 years in Zambia during 2021. Data were extracted from the SmartCare EHR, which covers ~90% of PLHIV on treatment in Zambia. PLHIV with >=2 recorded blood pressure (BP) readings in 2021 were included. Hypertension was defined as >=2 elevated BP readings (i.e., systolic BP of >=140 mmHg or diastolic BP of >=90 mmHg) during 2021 and/or on anti-hypertensive medication recorded in their EHR in the past five years. Multivariable logistic regression was used to assess associations between hypertension and independent variables. Results Among 750,098 PLHIV aged >=8 years with >=2 visits in SmartCare during 2021, 101,363 (13.5%) had >=2 blood pressure readings recorded in their EHR. Among these PLHIV, 14.7% (95% confidence interval [CI]: 14.5-14.9) had hypertension during 2021. Only 8.9% of PLHIV with hypertension had an anti-hypertensive medication recorded in their EHR. The odds of hypertension were greater in older age groups compared to PLHIV aged 18-29 years (adjusted odds ratio [aOR] for 30-44 years: 2.6 [95% CI: 2.4-2.9]; aOR for 45-49 years: 6.4 [95% CI: 5.8-7.0]; aOR for >=60 years: 14.5 [95% CI: 13.1-16.1]), urban areas (aOR: 1.9 [95% CI: 1.8-2.1]), and persons prescribed ART for >=6-month at a time (aOR: 1.1 [95% CI: 1.0-1.2]). Discussion Hypertension was common among a cohort of PLHIV in Zambia, with few having documentation of being on antihypertensive treatment. Most PLHIV were excluded from the analysis because of missing BP measurements in their EHR. Strengthening integrated management of non-communicable diseases in ART clinics might help to diagnose and treat hypertension in Zambia. Data completeness needs to be improved to routinely capture cardiovascular disease risk factors, including blood pressure readings consistently for PHLIV in their EHRs.

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High rate of uncontrolled hypertension among adults receiving integrated HIV and hypertension care with aligned multi‐month dispensing in Malawi: results from a cross‐sectional survey and retrospective chart review

Whitehead,

Phiri,

Kalande

et al. 2024

J Int AIDS Soc.

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IntroductionPeople living with HIV have high rates of hypertension. Integrated HIV and hypertension care with aligned multi‐month dispensing of medications (MMD) could decrease the burden of care for individuals and health systems. We sought to describe hypertension control and evaluate its association with different durations of MMD among Malawian adults receiving integrated care with aligned dispensing of antiretroviral therapy (ART) and antihypertensive medication.MethodsWe conducted a cross‐sectional survey and retrospective chart review of adults (≥18 years) receiving integrated HIV and hypertension care on medications for both conditions for at least 1 year, with aligned MMD at seven clinics in Malawi. Data were collected from July 2021 to April 2022 and included socio‐demographics, clinical characteristics, antihypertensive medications and up to the three most recent blood pressure measurements. Bivariate analyses were used to characterize associations with hypertension control. Uncontrolled hypertension was defined as ≥2 measurements ≥140 and/or ≥90 mmHg. Chart reviews were conducted for a random subset of participants with uncontrolled hypertension to describe antihypertensive medication adjustments in the prior year.ResultsWe surveyed 459 adults receiving integrated care with aligned dispensing (58% female; median age 54 years). Individuals most commonly received a 3‐month aligned dispensing of ART and antihypertensive medications (63%), followed by every 6 months (16%) and every 4 months (15%). Hypertension control was assessed in 359 respondents, of whom only 23% had controlled hypertension; 90% of individuals in this group reported high adherence to blood pressure medications (0−1 missed days/week). Control was more common among those with longer aligned medication dispensing intervals (20% among those with 1‐ to 3‐month dispensing vs. 28% with 4‐month dispensing vs. 40% with 6‐month dispensing, p = 0.011). Chart reviews were conducted for 147 individuals with uncontrolled hypertension. Most had high self‐reported adherence to blood pressure medications (89% missing 0−1 days/week); however, only 10% had their antihypertensive medication regimen changed in the prior year.ConclusionsUncontrolled hypertension was common among Malawian adults receiving integrated care with aligned MMD and was associated with shorter refill intervals and few antihypertensive medication escalations. Integrated care with aligned MMD is promising, but further work is needed to understand how to optimize hypertension outcomes.

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Integrated multi-month dispensing of antihypertensive and antiretroviral therapy to sustain hypertension and HIV control

Cited by 13 publications

References 26 publications

Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment

Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment

Hypertension among persons living with HIV — Zambia, 2021; A cross-sectional study of a national electronic health record system

High rate of uncontrolled hypertension among adults receiving integrated HIV and hypertension care with aligned multi‐month dispensing in Malawi: results from a cross‐sectional survey and retrospective chart review

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