Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation
| Autor: | Moses R. Kamya, Laura B. Balzer, Diane V. Havlir, Prashant Kotwani, Craig R. Cohen, Dalsone Kwarisiima, Tamara D. Clark, Dhruv S. Kazi, Maya L. Petersen, Gabriel Chamie, Dathan M Byonanabye, Florence Mwangwa, Vivek Jain, Edwin D. Charlebois, James Ayieko, David J. Heller, James G. Kahn |
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| Přispěvatelé: | Torpey, Kwasi |
| Rok vydání: | 2020 |
| Předmět: |
RNA viruses
Rural Population Male Health Screening Physiology HIV Infections Blood Pressure Cardiovascular Pathology and Laboratory Medicine Vascular Medicine Ambulatory Care Facilities Body Mass Index Geographical Locations Endocrinology 0302 clinical medicine Immunodeficiency Viruses Medicine and Health Sciences Medicine Mass Screening Public and Occupational Health Uganda 030212 general & internal medicine Young adult Measured blood pressure Multidisciplinary Implementation fidelity Health Services Middle Aged 3. Good health Physiological Parameters Medical Microbiology Viral Pathogens Viruses Hypertension HIV/AIDS Female Pathogens Research Article Adult medicine.medical_specialty Adolescent Endocrine Disorders General Science & Technology Science 030231 tropical medicine MEDLINE Microbiology 03 medical and health sciences Young Adult Clinical Research Behavioral and Social Science Retroviruses Diabetes Mellitus Humans Medical history cardiovascular diseases Risk factor Microbial Pathogens Mass screening business.industry Prevention Lentivirus Body Weight Organisms Biology and Life Sciences HIV Blood Pressure Determination Kenya Good Health and Well Being Blood pressure Metabolic Disorders Family medicine People and Places Africa business |
| Zdroj: | PloS one, vol 15, iss 1 PLoS ONE PLoS ONE, Vol 15, Iss 1, p e0222801 (2020) |
| Popis: | Author(s): Heller, David J; Balzer, Laura B; Kazi, Dhruv; Charlebois, Edwin D; Kwarisiima, Dalsone; Mwangwa, Florence; Jain, Vivek; Kotwani, Prashant; Chamie, Gabriel; Cohen, Craig R; Clark, Tamara D; Ayieko, James; Byonanabye, Dathan M; Petersen, Maya; Kamya, Moses R; Havlir, Diane; Kahn, James G | Abstract: BackgroundHypertension (HTN) is the single leading risk factor for human mortality worldwide, and more prevalent in sub-Saharan Africa than any other region [1]-although resources for HTN screening, treatment, and control are few. Most regional pilot studies to leverage HIV programs for HTN control have achieved blood pressure control in half of participants or fewer [2,3,4]. But this control gap may be due to inconsistent delivery of services, rather than ineffective underlying interventions.MethodsWe sought to evaluate the consistency of HTN program delivery within the SEARCH study (NCT01864603) among 95,000 adults in 32 rural communities in Uganda and Kenya from 2013-2016. To achieve this objective, we designed and performed a fidelity evaluation of the step-by-step process (cascade) of HTN care within SEARCH, calculating rates of HTN screening, linkage to care, and follow-up care. We evaluated SEARCH's assessment of each participant's HTN status against measured blood pressure and HTN history.FindingsSEARCH completed blood pressure screens on 91% of participants. SEARCH HTN screening was 91% sensitive and over 99% specific for HTN relative to measured blood pressure and patient history. 92% of participants screened HTN+ received clinic appointments, and 42% of persons with HTN linked to subsequent care. At follow-up, 82% of SEARCH clinic participants received blood pressure checks; 75% received medication appropriate for their blood pressure; 66% remained in care; and 46% had normal blood pressure at their most recent visit.ConclusionThe SEARCH study's consistency in delivering screening and treatment services for HTN was generally high, but SEARCH could improve effectiveness in linking patients to care and achieving HTN control. Its model for implementing population-scale HTN testing and care through an existing HIV test-and-treat program-and protocol for evaluating the intervention's stepwise fidelity and care outcomes-may be adapted, strengthened, and scaled up for use across multiple resource-limited settings. |
| Databáze: | OpenAIRE |
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