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
{"title":"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","authors":"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","doi":"10.1002/jia2.26500","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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 (<i>n</i> = 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 (<i>n</i> = 919), 96% received antihypertensive medication, 81% were retained in care at 1 year and 79% achieved BP control; people with HIV (<i>n</i> = 120) had similar retention (80%) and BP control (80%).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S3","pages":""},"PeriodicalIF":4.6000,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26500","citationCount":"0","resultStr":"{\"title\":\"A prospective cohort study of the SEARCH integrated HIV/hypertension community health worker-led intervention in rural Kenya and Uganda\",\"authors\":\"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\",\"doi\":\"10.1002/jia2.26500\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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 (<i>n</i> = 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 (<i>n</i> = 919), 96% received antihypertensive medication, 81% were retained in care at 1 year and 79% achieved BP control; people with HIV (<i>n</i> = 120) had similar retention (80%) and BP control (80%).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>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.</p>\\n </section>\\n </div>\",\"PeriodicalId\":201,\"journal\":{\"name\":\"Journal of the International AIDS Society\",\"volume\":\"28 S3\",\"pages\":\"\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-07-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26500\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the International AIDS Society\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/jia2.26500\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the International AIDS Society","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jia2.26500","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
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.
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.