Understanding the Hypertension screening gap in Uganda's HIV primary care setting

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Hypertension is the one of the major modifiable non-communicable comorbidities even amongst HIV-infected adults in routine primary care. Since hypertension is asymptomatic, screening with blood pressure measurement during routine visits may afford the only opportunity to find those affected early. Early disease (with uncomplicated hypertension) intervention is attractive since it would be less costly and would stem the development of the difficult and expensive to treat end-organ complications. Recent World Health Organization (WHO) and Uganda National Anti-retroviral therapy (ART) treatment guidelines, recommend both the screening and management of hypertension to further enhance longevity, and quality of life for HIV-infected patients on ART. An effective response to this begins with an effective screening program. With 10 million patients on ART in Sub-Saharan Africa, it is not yet clear how to best screen for hypertension in a usually busy primary care setting where patient numbers are ever growing and clinicians are mostly trained to provide ART. It is imperative therefore to first examine the hypertension cascade in a typical primary care setting. Therefore in Aim 1 we shall describe the screening gap for hypertension among 1500 HIV infected adults on ART at Uganda Cares HIV primary care clinic in Masaka, Uganda. We shall use the existing database at the clinic and patient charts to count how many patients have a record of at least a blood pressure measurement in the past 12 months. For those with abnormal blood pressure we shall record the action taken to determine whether the it was adequate or inadequate. In Aim 2, at the same clinic, we shall use in-depth interviews with 30 health providers and administrators to explain the current level of performance screening. This process will be guided by the Capability Opportunity Motivation and Behavior (COM-B) theoretical framework in both the design and analysis stages. This mixed methods approach will enable us make a behavioral diagnosis regarding screening in primary care. Also it will provide us with necessary armamentarium for designing appropriate interventions to enhance screening in an Ugandan HIV primary care facility when we map COM-B constructs to the Behavior Change Wheel intervention functions.