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Integrated Hypertension and HIV Care Cascades in an HIV Treatment Program in Eastern Uganda

A Retrospective Cohort Study

Muddu, Martin MMeda,b; Tusubira, Andrew K. MPHb; Sharma, Srish K. BScc; Akiteng, Ann R. MPHb; Ssinabulya, Isaac MMeda,b,d; Schwartz, Jeremy I. MDb,e

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15, 2019 - Volume 81 - Issue 5 - p 552–561
doi: 10.1097/QAI.0000000000002067
Clinical Science

Background: Persons living with HIV (PLHIV) are at increased risk of cardiovascular disease. Integration of services for hypertension (HTN), the primary cardiovascular disease risk factor, into HIV care programs is recommended in Uganda, though, uptake has been limited. We sought to compare the care cascades for HTN and HIV within an HIV program in Eastern Uganda.

Methods: We conducted a retrospective cohort study of all PLHIV enrolled in 3 HIV clinics between 2014 and 2017. We determined the proportion of patients in the following cascade steps over 12 months: Screened, Diagnosed, Initiated on treatment, Retained, Monitored, and Controlled. Cascades were analyzed using descriptive statistics and compared using χ2 and t tests.

Results: Of 1649 enrolled patients, 98.5% were initiated on HIV treatment, of whom 70.7% were retained in care, 100% had viral load monitoring, and 90.3% achieved control (viral suppression). Four hundred fifty-six (27.7%) participants were screened for HTN, of whom 46.9% were diagnosed, 88.1% were initiated on treatment, 57.3% were retained in care, 82.7% were monitored, and 24.3% achieved blood pressure control. There were no differences in any HIV cascade step between participants with HIV alone and those with both conditions.

Conclusions: The HIV care cascade approached global targets, whereas the parallel HTN care cascade demonstrated notable quality gaps. Management of HTN within this cohort did not negatively impact HIV care. Our findings suggest that models of integration should focus on screening PLHIV for HTN and retention and control of those diagnosed to fully leverage the successes of HIV programs.

aDepartment of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda;

bUganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD), Kampala, Uganda;

cWake Forest School of Medicine, Winston-Salem, NC;

dUganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda; and

eSection of General Internal Medicine, Yale School of Medicine, CT.

Correspondence to: Martin Muddu, MMed, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda (e-mail:

Supported by Fogarty International Center and the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health under the Global Health Equity Scholars Consortium at Yale University (D43TW010540). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funder had no role in the study design, data collection, analysis, or interpretation.

The authors have no conflicts of interest to disclose.

M.M. had full access to all the data and had the final responsibility for the decision to submit the manuscript for publication. M.M., I.S., and J.I.S. were responsible for the design of the study and interpretation of data. M.M. and A.K.T. led data collection and interpretation of data. A.K.T. performed data analysis. A.R.A. participated in study design and data interpretation. S.K.S. designed the figures for data presentation and participated in data analysis. All authors participated in writing the initial draft of the manuscript. M.M. and J.I.S. participated in writing the final manuscript. All authors read and approved the final manuscript before submission.

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Received January 26, 2019

Accepted April 01, 2019

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