World AIDS Day 2024: Multi-level perspectives on factors that impact hypertension screening, treatment, and management among people with HIV in South Africa
Published in Biomedical Research, General & Internal Medicine, and Public Health
Cardiovascular disease is the leading cause of death worldwide, and people living with HIV are at a higher risk. One major risk for cardiovascular disease is high blood pressure (i.e., hypertension), but many people with HIV, especially in South Africa, don't get the care they need for it. While there are guidelines for diagnosing and treating hypertension, routine blood pressure checks are often lacking. Since many people with HIV are already receiving care, combining hypertension treatment with HIV care could help improve health outcomes for this population.
What led to this study?
Our team interviewed and held group discussions with clinic staff and patients to understand the challenges and needs for better managing hypertension alongside HIV care. This study reports key factors that affect the way hypertension care is delivered, such as knowledge, support, and social and environmental influences that impact patients’ engagement with care. The findings will help develop better strategies to improve care by addressing the barriers and leveraging strengths identified in the healthcare system and community.
Why is this study important?
Despite hypertension being a major risk factor for cardiovascular disease, most people with HIV do not receive the recommended screening and treatment. Addressing hypertension alongside HIV care could significantly reduce the risk of cardiovascular disease and improve overall health outcomes, but there is not enough theory-driven research to create feasible and effective strategies for combining hypertension and HIV care in resource limited settings in a way that fits the specific needs of different clinical actors and people affected by these conditions. The findings from this study will help guide the design of more effective healthcare strategies and interventions, ensuring better care for people with HIV while optimizing the use of available healthcare resources.
Did this study find any differences between perspectives of different stakeholders?
One unexpected difference between the two groups was their view on the seriousness of the diseases. Patients seemed to think hypertension was more urgent, while clinic staff felt that treating HIV should be the main focus for people dealing with both conditions. Overall, the study emphasizes the need for better education for both patients and healthcare workers about hypertension and highlights the importance of improving healthcare systems to better manage both conditions.
What is the wider significance of the study findings?
Both patients and clinic staff pointed out that a lack of proper facility resources and clinic organization made it difficult to regularly check and treat high blood pressure. Many staff members also felt they didn’t have enough training on how to care for chronic conditions like high blood pressure. Despite these challenges, there was strong support among clinical actors for combining HIV and hypertension care. Staff suggested incorporating a stronger focus on chronic disease care in regularly held clinical trainings, providing additional resources, and offering rewards to motivate staff. However, they stressed that for this to work long-term, bigger changes are needed in the healthcare system. Interviews with people living with HIV and hypertension revealed key insights into their experiences with managing their condition. Many patients were motivated to change their lifestyle because they feared serious health problems, like strokes, caused by uncontrolled hypertension. However, they often found clinics difficult to navigate due to long wait times and lack of organization. Additionally, patients managed their condition with the help of family and community groups, but most expressed a need for more guidance and tools, like blood pressure machines, to help them monitor their health at home.
How were these findings used to inform future work?
A broader stakeholder group provided input on these data, allowing for a comprehensive understanding of how hypertension care could be improved in the South African context. Participatory research methods were then used to inform the design of implementation strategies aimed at promoting the adoption and implementation of guideline-recommended hypertension screening and management practices in local primary care settings. By centering the design of those strategies on data collected in this study, our team aims to overcome challenges at the patient, provider, and clinic-level that may hinder improved cardiovascular disease control in this high-risk population.
Geldsetzer P, Manne-Goehler J, Marcus ME, et al. The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults. Lancet. 2019, 394(10199):652-662. doi: 10.1016/S0140-6736(19)30955-9.
Wollum, A, Gabert R, McNellan CR, et al. Identifying gaps in the continuum of care for cardiovascular disease and diabetes in two communities in South Africa: Baseline findings from the HealthRise project. PLOS ONE. 2018; 13(3): e0192603.
Johnson LCM, Khan SH, Ali MK, et al. Understanding barriers and facilitators to integrated HIV and hypertension care in South Africa. Implement Sci Commun. 2024;5(1):87. doi: 10.1186/s43058-024-00625-5.
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Implementation Science Communications
An official companion journal to Implementation Science and a forum to publish research relevant to the systematic study of approaches to foster uptake of evidence based practices and policies that affect health care delivery and health outcomes, in clinical, organizational, or policy contexts.
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