Leveraging existing HIV differentiated service delivery models to screen and treat hypertension in Ugandan persons living with HIV for dual control

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Project summary Increased access to antiretroviral therapy has improved survival among persons living with HIV (PLHIV) and increased the proportion of elderly PLHIV (≥50 years) to >20% worldwide. Aging PLHIV experience higher rates of chronic non-communicable diseases (NCDs) including hypertension (HTN), kidney dysfunction, diabetes mellitus, metabolic syndrome and hyperlipidemia due to the ART and HIV-associated chronic inflammation. Concurrent administration of ART and medications for hypertension and other NCDs also raises concerns for medication-related adverse events, including adverse signs and symptoms and laboratory abnormalities. Little is known about the frequency or severity of adverse medication events among aging PLHIV in low-income countries like Uganda. The Uganda national guidelines for HIV management recommend monitoring for hypertension medication adverse events among PLHIV. However, adverse events monitoring is not happening routinely. In our parent K43 project, we are using implementation science methods and a quasi- experimental trial to compare clinic and community-based models for treating aging hypertensive PLHIV, following Uganda national treatment guidelines. To address the epidemiologic and implementation gap on adverse event monitoring, we have developed the current supplement proposal to add several research question to our K43 cohort to characterize the incidence, types, severity and predictors of hypertension medication adverse events among aging PLHIV and inform the development of management approaches. This study will generate pilot data for future research to evaluate the implementation, effectiveness, and costs of an adverse events screening and management strategy and decision aid for providers and patients.