Keywords
1. HIV and hypertension integrated care
2. Hypertension control in sub-Saharan Africa
3. Chronic disease management in Uganda
4. SEARCH study outcomes
5. HIV infrastructure hypertension treatment
Introduction
The dual epidemic of HIV and hypertension (HTN) is a mounting healthcare challenge in sub-Saharan Africa, with Uganda constituting a significant case study. Adapting HIV treatment infrastructure to address chronic diseases like HTN could be a solution, yet empirical evidence on the efficacy of such integrated care models has been sparse. Reporting on a ground-breaking integrated care approach, this article divulges the outcomes of the SEARCH study, a project aimed at reshaping HTN management by capitalizing on existing HIV care systems in Uganda.
The SEARCH Strategy
This initiative is illuminated by a publication in BMC Public Health (DOI: 10.1186/s12889-019-6838-6), which details an expansive population screening across ten communities for HIV and HTN, among other illnesses. Dalsone Kwarisiima and colleagues from institutions like the Infectious Diseases Research Collaboration and University of California San Francisco observed 34,704 adults, with 4554 requiring care for HTN alone or alongside HIV. A longitudinal follow-up over three years showed an increase in controlled HTN cases from 15% at baseline to 46% post-baseline, indicating that using HIV care frameworks can effectively manage HTN.
Methods and Progress
SEARCH’s tact was to refer subjects with HTN or concurrent HIV and HTN to an integrated chronic disease clinic. Holding to Uganda’s treatment protocols, these clinics arranged follow-up visits every four weeks for uncontrolled blood pressure (BP), stretching to three months when BP stabilized, barring any drug stockouts. Such scheduling highlighted challenges tied to the supply chain rather than clinical needs, potentially hampering HTN control.
Results
The SEARCH study’s integrated model fostered an improvement in HTN control, despite the logistical hurdles. Interestingly, the HIV-infected cohort had marginally better BP outcomes at follow-up than their uninfected counterparts. Addressing both conditions concurrently may have synergistic benefits, leveraging the infrastructure and experience gained from managing HIV—a notion supported by the apparent success reflected in higher HTN control among HIV patients.
Discussion
The role of treatment frequency emerges as a pivotal factor, with drug availability-driven scheduling noted to impair HTN control more than clinically indicated intervals. This pattern mirrors similar findings in HIV care, where systematic ART delivery models, such as the one in Uganda and Kenya by Kwarisiima et al., have been associated with high viral suppression rates. Pioneering such a principle in managing HTN could correct the course for patients suffering from multiple chronic conditions.
Ethical Considerations and Limitations
The study received the necessary ethical approvals, and informed consent was collected from all participants. There were certain limitations, including the potential influence of social determinants not thoroughly explored, like socioeconomic status, which is known to impact HTN control as documented by Antignac et al., and the impact of intermittent drug availability critical to continuous care.
Implications for Policy and Practice
The SEARCH study initiates a pertinent discussion on healthcare policy and the structure of chronic disease management in low-resource settings. Particular attention ought to be given to integrating care systems, strengthening supply chains per Pastakia et al., and promoting infrastructural investments mirroring the success of HIV treatment delivery.
Conclusion
The SEARCH study sets an empirical precedent for the integration of HIV and HTN care in sub-Saharan Africa. Incremental progress in HTN control within HIV infrastructure speaks to the potential of scalability across the region, where undiagnosed and untreated HTN is too common, as observed by Ataklte et al. This model could stimulate a transformative shift in managing the expanding burden of noncommunicable diseases against the backdrop of pervasive infectious diseases like HIV.
References
1. Kwarisiima, D., et al. (2019). Hypertension control in integrated HIV and chronic disease clinics in Uganda in the SEARCH study. BMC Public Health, 19(1), 511. doi: 10.1186/s12889-019-6838-6.
2. Lim, S. S., et al. (2012). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet, 380(9859), 2224–2260. doi: 10.1016/S0140-6736(12)61766-8.
3. Antignac, M., et al. (2018). Socioeconomic Status and Hypertension Control in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Hypertension, 71(4), 577–584. doi: 10.1161/HYPERTENSIONAHA.117.10512.
4. Ataklte, F., et al. (2015). Burden of Undiagnosed Hypertension in Sub-Saharan Africa. Hypertension, 65(2), 291–298. doi: 10.1161/HYPERTENSIONAHA.114.04394.
5. Pastakia, S. D., et al. (2018). Building reliable supply chains for noncommunicable disease commodities: lessons learned from HIV and evidence needs. AIDS, 32, S55–S61. doi: 10.1097/QAD.0000000000001878.
The SEARCH study’s findings highlight a pioneering integrated care pathway that has shown efficacy in controlling HTN in HIV-prevalent regions like rural Uganda. The sustainable restructuring of existing healthcare systems guided by this pragmatic approach could spark transformative progress in managing the dual threats of HIV and noncommunicable diseases in sub-Saharan Africa and beyond.