Abstract:
Setting: Academic Model of Providing Access to Healthcare (AMPATH), Kenya, provides care
to over 160,000 actively enrolled patients in catchment area of 4 million people.
Methods: Using a difference-in-differences design, we analyzed retrospective clinical records of
3603 patients with comorbid HIV and hypertension during 2009–2016 to evaluate the addition of
chronic disease management (CDM) to an existing HIV care program. Outcomes were blood
pressure (BP), hypertension control, and adherence to HIV care.
Results: Compared to the HIV standard of care, the addition of CDM produced statistically
significant, though clinically small improvements in hypertension control, decreasing systolic BP
by 0.76mmHg (p<0.001), diastolic BP by 1.28mmHg (p<0.001), and increasing the probability of
BP<140/90mmHg by 1.51 percentage points (p<0.001). However, sustained control of
hypertension for >1 year improved by 7 percentage points (p<0.001), adherence to HIV care
improved by 6.8 percentage points (p<0.001) and retention in HIV care with no gaps >6months
increased by 10.5 percentage points (p<0.001).
Conclusion: A CDM program that co-locates NCD and HIV care shows potential to improve
blood pressure and retention in care. Further evaluation of program implementation across settings
can inform how to maximize hypertension control among patients with comorbid HIV, and better
understand the effect on adherence.
