Low levels of hypertension screening in HIV care clinics in rural Uganda: A mixed methods study

Background The prevalence of hypertension among people living with HIV (PLHIV) has increased over the last decade globally. Given the dual burden of disease and significant prior investment in HIV care, integrating care for hypertension and HIV is recommended. However, data on hypertension screening, treatment, and control before such integration are lacking. Using a mixed-methods approach, we assessed the baseline status of hypertension screening, treatment, and control in 52 Ugandan public health facilities, participating in an ongoing cluster randomised trial of an integrated HIV/HTN care model. Methods From November 2020 to March 2021, we reviewed patient records and randomly sampled 50 PLHIV without a documented hypertension diagnosis per health facility and all PLHIV with a documented hypertension diagnosis per health facility. We surveyed the sampled participants, measured their blood pressure, and described the hypertension care cascade. We also conducted in-depth interviews with 24 patients and 12 providers to explore their experience with hypertension screening and care. We used an in-depth thematic approach to analyze the resulting qualitative data. Results Among 2,645 PLHIV,