一项在肯尼亚和乌干达农村地区进行的艾滋病毒/高血压社区卫生工作者干预的前瞻性队列研究

IF 4.6 1区 医学 Q2 IMMUNOLOGY
Matthew D. Hickey, Asiphas Owaraganise, Sabina Ogachi, Helen Sunday, Colette Aoko, Norton Sang, George Agengo, Jane Kabami, Elijah Kakande, Erick Wafula Mugoma, Josh Schwab, Nicole Sutter, Douglas Black, Anthony Muiru, Gabriel Chamie, Maya L. Petersen, Laura B. Balzer, Elizabeth A. Bukusi, Diane V. Havlir, Moses R. Kamya, James Ayieko
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引用次数: 0

摘要

对感染和不感染艾滋病毒的人进行临床高血压筛查和治疗取决于始终如一的临床参与。在农村地区,特别是对患有严重高血压的人来说,保持治疗是一项挑战,这通常需要比临床稳定的艾滋病毒患者更频繁地就诊。我们假设卫生部(MoH)社区卫生工作者(CHWs)可以通过高血压/艾滋病毒综合干预改善严重高血压的检测和治疗。方法:在乌干达和肯尼亚农村,我们在一项正在进行的群体随机研究中,在CHW工作流程中加入了HIV检测和状态中性高血压干预(SEARCH:NCT05768763)。数据跨度为2023年3月至2024年8月。训练有素的CHWs筛查干预社区中所有年龄≥40岁的成年人的高血压,将血压(BP)≥140/90 mmHg的人转介到卫生部HIV/初级保健诊所。初步临床评估后,血压≥160/100 mmHg的成人可选择临床或远程医疗(CHW家访、临床医生远程医疗评估、药物递送)随访护理。远程医疗使用了与卫生部兼容的CHW智能手机应用程序,该应用程序与电子诊所记录同步,提示CHW随访,并促进临床医生远程医疗评估/药物处方。我们报告了通过实施chw支持的筛查和远程医疗实现的高血压控制,并使用有针对性的基于最小损失的估计来估计从基线到1年不受控制的高血压人口患病率的变化。结果在8个社区中,198名CHWs在基线时对14378 / 15879名≥40岁的成年人(91%)和1年后对13334 / 15879名成年人(84%)进行了血压测量;其中55%为女性,19%为艾滋病毒携带者。估计人群中血压≥140/90 mmHg的患病率从基线时的16.0%下降到第一年时的6.4%(绝对下降9.6%,95% CI 8.6%, 10.6%)。在年龄≥40岁的HIV感染者中(n = 3036),血压≥140/90 mmHg的患病率从10.5%下降到4.7%(绝对下降5.9%,95% CI 3.0%, 8.8%)。在参与干预的血压≥160/100组(n = 919)中,96%的患者接受了降压药物治疗,81%的患者在1年后仍在治疗,79%的患者血压得到控制;艾滋病毒感染者(n = 120)有相似的滞留(80%)和血压控制(80%)。在一项实用试验的背景下,在HIV/高血压综合模型中利用现有的chw,将HIV感染者和非HIV感染者中未控制的高血压患病率降低了60%,大规模地将卫生服务扩展到社区。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

A prospective cohort study of the SEARCH integrated HIV/hypertension community health worker-led intervention in rural Kenya and Uganda

A prospective cohort study of the SEARCH integrated HIV/hypertension community health worker-led intervention in rural Kenya and Uganda

Introduction

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 clinically stable HIV. We hypothesised that Ministry of Health (MoH) community health workers (CHWs) could improve severe hypertension detection and treatment 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-randomised population-level study (SEARCH:NCT05768763). Data spans March 2023–August 2024. Trained CHWs screened all adults aged ≥ 40 years in intervention communities for hypertension, referring those with blood pressure (BP) ≥ 140/90 mmHg to MoH HIV/primary care clinics. After initial in-clinic evaluation, adults with BP ≥ 160/100 mmHg 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 hypertension control achieved through the implementation of CHW-supported screening and telehealth and used targeted minimum loss-based estimation to estimate the change in population prevalence of uncontrolled hypertension from baseline to 1 year.

Results

Across eight communities, 198 CHWs measured BP in 14,378/15,879 adults aged ≥ 40 years at baseline (91%) and 13,334/15,879 after 1 year (84%); 55% were female and 19% living with HIV. Estimated population prevalence of BP ≥ 140/90 mmHg decreased from 16.0% at baseline to 6.4% at year 1 (9.6% absolute decrease, 95% CI 8.6%, 10.6%). Among people with HIV aged ≥ 40 years (n = 3036), the prevalence of BP ≥ 140/90 mmHg decreased from 10.5% to 4.7% (5.9% absolute decrease, 95% CI 3.0%, 8.8%). In the subset with BP ≥ 160/100 who enrolled in the intervention (n = 919), 96% received antihypertensive medication, 81% were retained in care at 1 year and 79% achieved BP control; people with HIV (n = 120) had similar retention (80%) and BP control (80%).

Conclusions

Within the context of a pragmatic trial, leveraging existing CHWs in an integrated HIV/hypertension model reduced the population-level prevalence of uncontrolled hypertension by 60% among people with and without HIV, extending health services into the community at scale.

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来源期刊
Journal of the International AIDS Society
Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
8.60
自引率
10.00%
发文量
186
审稿时长
>12 weeks
期刊介绍: The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
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