Hypertension control andretention in care among HIV infected patients: The effects of co- located HIV and chronic non-communicable disease care

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.