Journal Article

Effect of a patient-centered hypertension delivery strategy on all-cause mortality: Secondary analysis of SEARCH, a community-randomized trial in rural Kenya and Uganda

Balzer, Laura B., Petersen, Maya L., Peng, James, Owaraganise, Asiphas, Wafula, Erick, Jain, Vivek, Charlebois, Edwin D., Bukusi, Elizabeth A., Kamya, Moses R., Hickey, Matthew D., Cohen, Craig R., Atukunda, Mucunguzi, Kwarisiima, Dalsone, Brown, Lillian, Nyabuti, Marilyn, Ayieko, James, Sim, Nicholas, Camlin, Carol S., Kabami, Jane, Opel, Fredrick J., Havlir, Diane V., Chamie, Gabriel

2021

Overview

Hypertension treatment reduces morbidity and mortality yet has not been broadly implemented in many low-resource settings, including sub-Saharan Africa (SSA). We hypothesized that a patient-centered integrated chronic disease model that included hypertension treatment and leveraged the HIV care system would reduce mortality among adults with uncontrolled hypertension in rural Kenya and Uganda. This is a secondary analysis of the SEARCH trial (NCT:01864603), in which 32 communities underwent baseline population-based multidisease testing, including hypertension screening, and were randomized to standard country-guided treatment or to a patient-centered integrated chronic care model including treatment for hypertension, diabetes, and HIV. Patient-centered care included on-site introduction to clinic staff at screening, nursing triage to expedite visits, reduced visit frequency, flexible clinic hours, and a welcoming clinic environment. The analytic population included nonpregnant adults ([greater than or equal to]18 years) with baseline uncontrolled hypertension (blood pressure [greater than or equal to]140/90 mm Hg). The primary outcome was 3-year all-cause mortality with comprehensive population-level assessment. Secondary outcomes included hypertension control assessed at a population level at year 3 (defined per country guidelines as at least 1 blood pressure measure <140/90 mm Hg on 3 repeated measures). Between-arm comparisons used cluster-level targeted maximum likelihood estimation. In this cluster randomized comparison where both arms received population-level hypertension screening, implementation of a patient-centered hypertension care model was associated with a 21% reduction in all-cause mortality and a 22% improvement in hypertension control compared to standard care among adults with baseline uncontrolled hypertension. Patient-centered chronic care programs for HIV can be leveraged to reduce the overall burden of cardiovascular mortality in SSA.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Algorithms / Biology and Life Sciences / Blood pressure / Cardiovascular diseases / Care and treatment / Clinics / Community health services / Comorbidity / Diabetes / Diabetes mellitus / Health aspects / HIV / HIV infection / Human immunodeficiency virus / Hypertension / Infections / Intervention / Kenya / Medicine and Health Sciences / Morbidity / Mortality / Patient outcomes / Patients / People and Places / Population / Rural population / Statistical analysis / Uganda / Workforce planning