Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation

• DOI: 10.1371/journal.pone.0222801
• Publication Date: 2020-01-15T13:50:29Z
• Authors: David J. Heller; Laura B. Balzer; Dhruv Kazi; Edwin D. Charlebois; Dalsone Kwarisiima; Florence Mwangwa; Vivek Jain; Prashant Kotwani; Gabriel Chamie; Craig R. Cohen; Tamara D. Clark; James Ayieko; Dathan M. Byonanabye; Maya Petersen; Moses R. Kamya; Diane Havlir; James G. Kahn
• Keywords: Adult; Male; Rural Population; Adolescent; General Science & Technology; Science; Clinical Trials and Supportive Activities; Blood Pressure; HIV Infections; 613; Cardiovascular; Ambulatory Care Facilities; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Clinical Research; Health Services and Systems; Behavioral and Social Science; Health Sciences; Humans; Mass Screening; Uganda; 10. No inequality; Biomedical and Clinical Sciences; Prevention; Q; R; Blood Pressure Determination; Health Services; Middle Aged; 16. Peace & justice; Kenya; 004; 3. Good health; Infectious Diseases; Good Health and Well Being; Hypertension; HIV/AIDS; Sexually Transmitted Infections; Medicine; Female; Public Health; Research Article

Hypertension (HTN) is the single leading risk factor for human mortality worldwide, and more prevalent in sub-Saharan Africa than any other region [1]-although resources HTN screening, treatment, control are few. Most regional pilot studies to leverage HIV programs have achieved blood pressure half of participants or fewer [2,3,4]. But this gap may be due inconsistent delivery services, rather ineffective underlying interventions.We sought evaluate consistency program within SEARCH study (NCT01864603) among 95,000 adults 32 rural communities Uganda Kenya from 2013-2016. To achieve objective, we designed performed a fidelity evaluation step-by-step process (cascade) care SEARCH, calculating rates linkage care, follow-up care. We evaluated SEARCH's assessment each participant's status against measured history.SEARCH completed screens on 91% participants. screening was sensitive over 99% specific relative patient history. 92% screened HTN+ received clinic appointments, 42% persons with linked subsequent At follow-up, 82% checks; 75% medication appropriate their pressure; 66% remained care; 46% had normal at most recent visit.The study's delivering treatment services generally high, but could improve effectiveness linking patients achieving control. Its model implementing population-scale testing through an existing test-and-treat program-and protocol evaluating intervention's stepwise outcomes-may adapted, strengthened, scaled up use across multiple resource-limited settings.