Hypertension can be defined as having chronically high blood pressure and is diagnosed if, when it is measured on two different days, the systolic blood pressure readings on both days is greater than or equal to 140mmHg and/or the diastolic blood pressure readings on both days is greater than or equal to 90mmHg. It is a leading cause of death worldwide, responsible for 13.5% of all global mortality(1). It is also the leading risk factor for cardiovascular and cerebrovascular mortality worldwide, and is thought to be responsible for 45% of deaths due to heart disease and 51% of deaths due to stroke in 2013(2). The age-adjusted adult prevalence of hypertension in sub-saharan Africa is the highest in the world at approximately 46%(3). The World Health Organization (WHO) projects that non-communicable diseases (NCDs), such as hypertension will cause 55 million deaths annually by 2030 which is an increase from the current 41 million deaths annually caused by NCDs(4). HIV is more prevalent in Sub-Saharan Africa than anywhere else in the world(5). The HIV epidemic in Sub-Saharan Africa has complicated the efforts to understand and control hypertension in the region, this is because of all the comorbidities in HIV- positive populations, hypertension and cardiovascular disease have emerged as among the most important contributors of non-AIDS related mortality. Antiretroviral therapy scale-up in Sub-Saharan Africa has created a growing, aging HIV-positive population due to substantial decline in HIV-associated morbidity and mortality leading to estimates of life expectancy among HIV-positive population to now approach that of the general population. As HIV-positive patients are now living longer and healthier lives than before, new epidemics of NCDs have emerged as a serious public health concern with hypertension being among them. However, the prevalence and risk factors for hypertension in this population remain incompletely understood and this may be due to the additional costs and time associated with operating a CVD screening program in an already resource-limited environment. Moreover, whether ART medications or HIV itself interact with traditional risk factors for HTN remains unclear. Causative factors for the development of these conditions in HIV-positive populations is possibly similar to uninfected populations. However, CVD in HIV-positive populations may also be the result of opportunistic infections in the presence of advanced immunosuppression being a consequence of HIV-induced immune activation or derived from ART-associated dyslipedemia and insulin resistance. . The clinical management of hypertension in HIV-positive patients is similar to those with hypertension in the general population; however, additional considerations should be given to potential drug interactions between antihypertensive agents and antiretroviral drugs to inform the clinician’s selection of these therapies.
1.2 Problem Statement
HIV infection is associated with increased cardiovascular risk including hypertension(6). This is due to HIV related factors and the effect of antiretroviral treatment. Currently there is little integration between HIV and non-communicable disease services. This study will provide data reinforcing the need of integration of the two services to ensure optimal uptake of both HIV and hypertension treatment at the HIV clinics.
1.3 Rationale of the Study
As previously stated currently there is little integration between HIV and NCD services and this is because evidence-based care models for scaling up integrated HIV/NCD care are lacking. In particular, little is known about the health systems factors that might influence HTN control when leveraging HIV chronic care systems to provide care for persons with hypertension, with or without co-occuring HIV infection. This study aims at establishing whether or not there is a significant causal relationship between HIV/AIDS and hypertension and therefore establish whether or not there is a need for integration of services of these two diseases as integrated care systems are more convenient for patients, decrease stigma associated with healthcare, and could be more efficient for government and non-governmental funders.
1.4 Research questions
1. What is the magnitude of hypertension among HIV infected patients at Bugando medical center? 2. What is the uptake rate of hypertension treatment among HIV infected patients with hypertension at Bugando medical center?
1.5 Research objectives
1.5.1 Broad Objective
To determine the prevalence of hypertension and uptake of hypertension treatment among HIV infected patients at Bugando medical center. 1.5.2 Specific Objectives
1. To determine the prevalence of hypertension among HIV infected patients at Bugando medical center 2. To determine the prevalence of uptake of hypertension treatment among HIV infected patients with hypertension at Bugando medical center.