"It's because I think too much": Perspectives and experiences of adults with hypertension engaged in HIV care in northern Tanzania.
"It's because I think too much": Perspectives and experiences of adults with hypertension engaged in HIV care in northern Tanzania.
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DOI：
10.1371/journal.pone.0243059
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Watt MH
中科院分区：
文献类型：
--
作者：
Manavalan P;Minja L;Wanda L;Hertz JT;Thielman NM;Okeke NL;Mmbaga BT;Watt MH
高血压是导致心血管疾病死亡的主要危险因素，也是艾滋病毒感染者（PLHIV）的一种重要共病。在坦桑尼亚，艾滋病毒感染者的高血压患病率接近20%至30%。然而，大多数患者不知道他们的诊断，也没有接受治疗。了解高血压治疗的障碍是制定干预措施以改善坦桑尼亚和类似环境中艾滋病毒感染者心血管结局的关键第一步。2018年9月1日至11月26日期间，对坦桑尼亚北方政府卫生机构的两个艾滋病诊所从事艾滋病护理的高血压患者进行了13次半结构化深入访谈。访谈进行了录音，翻译成英文，转录和主题编码使用NVivo。数据分析采用应用专题分析法。参与者的中位年龄为54岁（IQR 41-65）。在13名参与者中，8名参与者表示他们之前使用过降压药物，但只有1名参与者描述了目前使用的降压治疗。所有参与者目前都在接受抗逆转录病毒治疗。数据显示了一系列主题，包括有限的高血压知识。普遍而言，所有参与者都认为“思考太多”，即压力，是高血压的主要原因，通过“减少思考”，可以控制高血压。其他新出现的主题包括高血压和艾滋病毒之间的重叠，高血压诊断和护理的延迟，提供者沟通和咨询的挑战，对抗高血压药物的不情愿，缺乏高血压和艾滋病毒护理的整合，以及高血压护理的其他结构性障碍。与会者描述了与高血压管理相关的多重交叉挑战。艾滋病毒感染者特有的障碍包括孤立的护理、与艾滋病毒有关的耻辱和多种医疗条件的负担。迫切需要寻求解决结构性障碍，高血压教育，心理社会压力和耻辱，并纳入艾滋病毒护理的多方面战略，以改善撒哈拉以南非洲艾滋病毒感染者的心血管结局。
Hypertension, a leading risk for cardiovascular mortality, is an important co-morbidity among people living with HIV (PLHIV). In Tanzania, hypertension prevalence among PLHIV approaches 20 to 30%. However, most patients are unaware of their diagnosis and are not receiving treatment. Understanding the barriers to hypertension care is a critical first step in developing interventions to improve cardiovascular outcomes among PLHIV in Tanzania and similar settings. Between September 1st and November 26th, 2018 thirteen semi structured in-depth interviews were conducted with hypertensive patients engaged in HIV care in two HIV clinics located in government health facilities in northern Tanzania. Interviews were audio-recorded, translated into English, transcribed and thematically coded using NVivo. Data analysis was conducted using applied thematic analysis. Participants had a median age of 54 (IQR 41–65) years. Of the 13 participants, eight stated they had used antihypertensive medication previously, but only one participant described current use of antihypertensive therapy. All participants were currently using antiretroviral therapy. The data revealed a range of themes including limited hypertension knowledge. Universally, all participants believed that “thinking too much”, i.e. stress, was the major contributor to hypertension and that by “reducing thoughts”, one may control hypertension. Additional emerging themes included a perceived overlap between hypertension and HIV, delays in hypertension diagnosis and linkage to care, challenges with provider communication and counseling, reluctance towards antihypertensive medication, lack of integration of hypertension and HIV care, and additional structural barriers to hypertension care. Participants described multiple, intersecting challenges related to hypertension management. Barriers specific to PLHIV included siloed care, HIV-related stigma, and burden from multiple medical conditions. Multifaceted strategies that seek to address structural barriers, hypertension education, psychosocial stressors and stigma, and that are integrated within HIV care are urgently needed to improve cardiovascular outcomes among PLHIV in sub-Saharan Africa.
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影响因子：
4.5
作者：
Kwarisiima, Dalsone;Atukunda, Mucunguzi;Brown, Lillian B.
通讯作者：
Brown, Lillian B.
影响因子：
4.5
作者：
Leung C;Aris E;Mhalu A;Siril H;Christian B;Koda H;Samatta T;Maghimbi MT;Hirschhorn LR;Chalamilla G;Hawkins C
通讯作者：
Hawkins C
DOI：
10.1111/jch.13929
发表时间：
2020-08
期刊：
Journal of clinical hypertension (Greenwich, Conn.)
影响因子：
--
作者：
Manavalan P;Madut DB;Hertz JT;Thielman NM;Okeke NL;Mmbaga BT;Watt MH
通讯作者：
Watt MH
影响因子：
37.8
作者：
Feinstein MJ;Hsue PY;Benjamin LA;Bloomfield GS;Currier JS;Freiberg MS;Grinspoon SK;Levin J;Longenecker CT;Post WS
通讯作者：
Post WS
影响因子：
2.8
作者：
Murphy K;Chuma T;Mathews C;Steyn K;Levitt N
通讯作者：
Levitt N