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J Acquir Immune Defic Syndr. 2019 Dec 1;82(4):399-406. doi: 10.1097/QAI.0000000000002154.

Hypertension Control and Retention in Care Among HIV-Infected Patients: The Effects of Co-located HIV and Chronic Noncommunicable Disease Care.

Author information

1
Department of Health Services Policy & Practice, Brown University, School of Public Health, Providence, RI.
2
Department of Epidemiology and Public Health, Household Economics and Health Systems Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland.
3
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
4
Department of Medicine, Duke Global Health Institute, Duke Clinical Research Institute, Duke University, Durham, NC.
5
Department of Biostatistics, School of Public Health, Brown University, Providence, RI.
6
Department of Pharmacy Practice, Purdue University College of Pharmacy, Purdue Kenya Partnership, Eldoret, Kenya.
7
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
8
Department of Behavioral Science, School of Medicine, Moi University, Eldoret, Kenya.
9
Departments of Epidemiology.
10
Anthropology, School of Public Health, International Health Institute, Brown University, Providence, RI.

Abstract

BACKGROUND:

As the noncommunicable disease (NCD) burden is rising in regions with high HIV prevalence, patients with comorbid HIV and chronic NCDs may benefit from integrated chronic disease care. There are few evaluations of the effectiveness of such strategies, especially those that directly leverage and extend the existing HIV care system to provide co-located care for NCDs.

SETTING:

Academic Model of Providing Access to Healthcare, Kenya, provides care to over 160,000 actively enrolled patients in catchment area of 4 million people.

METHODS:

Using a difference-in-differences design, we analyzed retrospective clinical records of 3603 patients with comorbid HIV and hypertension during 2009-2016 to evaluate the addition of chronic disease management (CDM) to an existing HIV care program. Outcomes were blood pressure (BP), hypertension control, and adherence to HIV care.

RESULTS:

Compared with the HIV standard of care, the addition of CDM produced statistically significant, although clinically small improvements in hypertension control, decreasing systolic BP by 0.76 mm Hg (P < 0.001), diastolic BP by 1.28 mm Hg (P < 0.001), and increasing the probability of BP <140/90 mm Hg by 1.51 percentage points (P < 0.001). However, sustained control of hypertension for >1 year improved by 7 percentage points (P < 0.001), adherence to HIV care improved by 6.8 percentage points (P < 0.001) and retention in HIV care with no gaps >6 months increased by 10.5 percentage points (P < 0.001).

CONCLUSION:

A CDM program that co-locates NCD and HIV care shows potential to improve BP and retention in care. Further evaluation of program implementation across settings can inform how to maximize hypertension control among patients with comorbid HIV, and better understand the effect on adherence.

PMID:
31658183
PMCID:
PMC6822379
[Available on 2020-12-01]
DOI:
10.1097/QAI.0000000000002154

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