High rate of uncontrolled hypertension among adults receiving integrated HIV and hypertension care with aligned multi-month dispensing in Malawi: results from a cross-sectional survey and retrospective chart review.

Autor: Whitehead HS; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Phiri K; Partners in Hope, Lilongwe, Malawi., Kalande P; Partners in Hope, Lilongwe, Malawi., van Oosterhout JJ; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.; Partners in Hope, Lilongwe, Malawi., Talama G; Partners in Hope, Lilongwe, Malawi., Phiri S; Partners in Hope, Lilongwe, Malawi.; School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi., Moucheraud C; Department of Public Health Policy and Management, School of Global Public Health at NYU, New York City, New York, USA., Moses A; Partners in Hope, Lilongwe, Malawi., Hoffman RM; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Jazyk: angličtina
Zdroj: Journal of the International AIDS Society [J Int AIDS Soc] 2024 Sep; Vol. 27 (9), pp. e26354.
DOI: 10.1002/jia2.26354
Abstrakt: Introduction: People living with HIV have high rates of hypertension. Integrated HIV and hypertension care with aligned multi-month dispensing of medications (MMD) could decrease the burden of care for individuals and health systems. We sought to describe hypertension control and evaluate its association with different durations of MMD among Malawian adults receiving integrated care with aligned dispensing of antiretroviral therapy (ART) and antihypertensive medication.
Methods: We conducted a cross-sectional survey and retrospective chart review of adults (≥18 years) receiving integrated HIV and hypertension care on medications for both conditions for at least 1 year, with aligned MMD at seven clinics in Malawi. Data were collected from July 2021 to April 2022 and included socio-demographics, clinical characteristics, antihypertensive medications and up to the three most recent blood pressure measurements. Bivariate analyses were used to characterize associations with hypertension control. Uncontrolled hypertension was defined as ≥2 measurements ≥140 and/or ≥90 mmHg. Chart reviews were conducted for a random subset of participants with uncontrolled hypertension to describe antihypertensive medication adjustments in the prior year.
Results: We surveyed 459 adults receiving integrated care with aligned dispensing (58% female; median age 54 years). Individuals most commonly received a 3-month aligned dispensing of ART and antihypertensive medications (63%), followed by every 6 months (16%) and every 4 months (15%). Hypertension control was assessed in 359 respondents, of whom only 23% had controlled hypertension; 90% of individuals in this group reported high adherence to blood pressure medications (0-1 missed days/week). Control was more common among those with longer aligned medication dispensing intervals (20% among those with 1- to 3-month dispensing vs. 28% with 4-month dispensing vs. 40% with 6-month dispensing, p = 0.011). Chart reviews were conducted for 147 individuals with uncontrolled hypertension. Most had high self-reported adherence to blood pressure medications (89% missing 0-1 days/week); however, only 10% had their antihypertensive medication regimen changed in the prior year.
Conclusions: Uncontrolled hypertension was common among Malawian adults receiving integrated care with aligned MMD and was associated with shorter refill intervals and few antihypertensive medication escalations. Integrated care with aligned MMD is promising, but further work is needed to understand how to optimize hypertension outcomes.
(© 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)
Databáze: MEDLINE
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