Background
Clinic-based hypertension screening and treatment for people with and without HIV depends on consistent clinic engagement. Retention is challenging in rural areas, especially for people with severe hypertension which typically requires more frequent visits than stable HIV. We hypothesized that Ministry of Health (MoH) community health workers (CHWs) could be leveraged to improve hypertension outcomes through an integrated hypertension/HIV intervention.
Methods
In rural Uganda and Kenya, we added HIV testing and a status-neutral hypertension intervention to CHW workflow in an ongoing cluster-randomized population-level study (SEARCH:NCT05768763). Trained CHWs screened all adults aged ≥40 years in intervention communities for hypertension, referring those with blood pressure (BP) ≥140/90mmHg to MoH HIV/primary care clinics. After initial in-clinic evaluation, adults with BP ≥160/100mmHg were offered choice of clinic-based or telehealth (CHW home visit, clinician telehealth evaluation, medication delivery) follow-up care. Telehealth used a MoH-compatible CHW smartphone app that syncs with electronic clinic records, prompts CHW follow-up visits, and facilitates clinician telehealth assessment/medication prescribing. We report i) hypertension control achieved through implementation of CHW-supported screening and telehealth and ii) resulting change in population prevalence of uncontrolled hypertension from baseline to 1 year.
Results
Across eight communities, 198 CHWs measured BP in 13,760/15,121 (91%) adults aged ≥40 yrs at baseline and 13,349/15,121 (89%) after 1 year; 55% were female and 19% living with HIV. Population prevalence of BP ≥140/90mmHg decreased from 17% at baseline to 7% at year 1 (p<0.001) and prevalence of BP ≥160/100mmHg decreased from 7% to 2% (p<0.001). Among people with HIV aged ≥40 yrs (n=2,643), prevalence of BP ≥140/90mmHg decreased from 11% to 4% (p<0.001) and prevalence of BP ≥160/100mmHg decreased from 4% to 1% (p<0.001). In the subset with BP ≥160/100 who enrolled in the telehealth intervention (n=958), 96% received hypertension medication, 94% had ≥1 follow-up visit, 81% were retained in care at 1 year, and 79% achieved BP control; people with HIV (n=111) had similar retention (84%) and BP control (82%).
Conclusions
Leveraging existing community health workers in an integrated HIV/hypertension model reduced population-level prevalence of uncontrolled hypertension by 59% among people with and without HIV, extending health services into the community at scale.
Table or Figure
