For people living with HIV (PLWH) in Africa, hypertension (HTN) is the leading cause of cardiovascular morbidity and mortality. However, despite increased access to effective antiretroviral therapy (ART), PLWH in Africa have limited access to high-quality care for cardiovascular diseases such as strokes, heart failure, and kidney diseases.
Looking to address this issue, Global Health Professor Chris Longenecker and other researchers are conducting the PULESA-Uganda study, which aims to improve blood pressure treatment for PLWH in Uganda in a scalable and sustainable manner.
Sharing their study protocol in a recent BMC Health Services Research article, the researchers detail how they aim to assess the effectiveness and cost-effectiveness of two different strategies of integrating blood pressure care into HIV clinics in Uganda. While HIV clinics in many African countries offer some wrap around services, this study follows a movement to work towards integrating more comprehensive care into the clinics.
“Clients like a one-stop shop where they can get all of their primary care needs met,” shares Professor Longenecker. “Through our costing work, we’ve found that patients end up spending a significant amount out of pocket for things like transportation to and from the clinic. The wait times to see a clinician are so long that it helps to get multiple problems addressed at once.”
Combining HIV and HTN care could have an additional benefit as well. Some of the proven methods used in HIV clinics, like customizing care to fit different patients' needs and using trained peer supporters, could be used to help people with high blood pressure. In the same way, strategies used for managing high blood pressure, like step-by-step treatment plans, could be useful in HIV care too.
Professor Longenecker is hoping that the study results, which will be released in 2026, will have a far-reaching impact across Uganda.
“We are pretty sure these strategies will have a positive impact on hypertension control rates, but it is really demonstrating the costs and cost-effectiveness of these strategies that will move policy makers to action. There is already a lot of support in the Uganda Ministry of Health to improve hypertension care for People with HIV and the entire general population. Having the costing numbers will help them plan to scale these strategies at a national level.”
This data could also help funders and policy makers expand these strategies to include other non-AIDS comorbidities into HIV clinics, as aging PLWH in LMIC are suffering from a host of other non-AIDS comorbidities that will require high functioning integrated primary care to maximally preserve the health benefits of ART.