Hypertension control in integrated HIV and chronic disease clinics in Uganda in the SEARCH study
Hypertension control in integrated HIV and chronic disease clinics in Uganda in the SEARCH study
复制标题
DOI：
10.1186/s12889-019-6838-6
复制
发表时间：
2019-05-06
影响因子：
4.5
通讯作者：
Brown, Lillian B.
中科院分区：
文献类型：
--
作者：
Kwarisiima, Dalsone;Atukunda, Mucunguzi;Brown, Lillian B.
在撒哈拉以南非洲，艾滋病毒感染率是世界上最高的，但目前的护理模式不足以解决双重流行病，高血压（HTN）的负担日益增加。艾滋病毒治疗基础设施可用于其他慢性病的护理，包括HTN。然而，几乎没有数据存在的综合艾滋病毒和慢性病护理提供系统的有效性对血压控制随着时间的推移。MethodsPopulation筛查艾滋病毒和HTN，在其他疾病，在乌干达农村10个社区进行的一部分，作为艾滋病研究（NCT 01864603）。患有HIV、HTN或两者兼而有之的个人被转诊到综合慢性病诊所。根据乌干达的治疗指南，当血压不受控制时，每4周安排一次随访，当血压得到控制时，每3个月或在药物缺货的情况下更频繁地安排一次随访。我们描述了所有患者的人口统计学和临床变量，并使用多层次混合效应logistic回归来评估HTN control. Resultsafter人口筛查（2013-2014年）的34,704名18岁的成年人，4554人与HTN单独或艾滋病毒和HTN被称为综合慢性病诊所。在1年内，2038名HTN参与者与护理有关，并在3年内提供了15，653次随访。HTN在15%的基线访视和46%（95% CI：44-48%）的基线后随访访视时得到控制。在控制HTN的患者中，计划访视间隔比临床适应症更频繁与后续访视时HTN控制较低相关（aOR= 0. 89; 95% CI 0. 79 - 0. 99）。随访时，艾滋病毒感染患者的高血压控制率高于随访时血压得到控制的未感染患者（48% vs 46%; aOR 1.28; 95%CI 0.95-1.71）。结论在综合艾滋病毒和慢性病护理模式中，HTN控制得到改善。与HIV护理类似，由药物供应链而不是临床指征确定的就诊频率与更差的HTN控制相关。ClinicalTrials.gov
BackgroundThere is an increasing burden of hypertension (HTN) across sub-Saharan Africa where HIV prevalence is the highest in the world, but current care models are inadequate to address the dual epidemics. HIV treatment infrastructure could be leveraged for the care of other chronic diseases, including HTN. However, little data exist on the effectiveness of integrated HIV and chronic disease care delivery systems on blood pressure control over time.MethodsPopulation screening for HIV and HTN, among other diseases, was conducted in ten communities in rural Uganda as part of the SEARCH study (NCT01864603). Individuals with either HIV, HTN, or both were referred to an integrated chronic disease clinic. Based on Uganda treatment guidelines, follow-up visits were scheduled every 4weeks when blood pressure was uncontrolled, and either every 3months, or in the case of drug stock-outs more frequently, when blood pressure was controlled. We describe demographic and clinical variables among all patients and used multilevel mixed-effects logistic regression to evaluate predictors of HTN control.ResultsFollowing population screening (2013-2014) of 34,704 adults age18years, 4554 individuals with HTN alone or both HIV and HTN were referred to an integrated chronic disease clinic. Within 1year 2038 participants with HTN linked to care and contributed 15,653 follow-up visits over 3years. HTN was controlled at 15% of baseline visits and at 46% (95% CI: 44-48%) of post-baseline follow-up visits. Scheduled visit interval more frequent than clinical indication among patients with controlled HTN was associated with lower HTN control at the subsequent visit (aOR=0.89; 95% CI 0.79-0.99). Hypertension control at follow-up visits was higher among HIV-infected patients than uninfected patients to have controlled blood pressure at follow-up visits (48% vs 46%; aOR 1.28; 95% CI 0.95-1.71).ConclusionsImproved HTN control was achieved in an integrated HIV and chronic care model. Similar to HIV care, visit frequency determined by drug supply chain rather than clinical indication is associated with worse HTN control.Trial registrationThe SEARCH Trial was prospectively registered with ClinicalTrials.gov: NCT01864603.