Effect of a patient-centered hypertension delivery strategy on all-cause mortality: Secondary analysis of SEARCH, a community-randomized trial in rural Kenya and Uganda

by Matthew D. Hickey, James Ayieko, Asiphas Owaraganise, Nicholas Sim, Laura B. Balzer, Jane Kabami, Mucunguzi Atukunda, Fredrick J. Opel, Erick Wafula, Marilyn Nyabuti, Lillian Brown, Gabriel Chamie, Vivek Jain, James Peng, Dalsone Kwarisiima, Carol S. Camlin, Edwin D. Charlebois, Craig R. Cohen, Elizabeth A. Bukusi, Moses R. Kamya, Maya L. Petersen, Diane V. Havlir BackgroundHypertension treatment reduces morbidity and mortality yet has not been broadly implemented in many low-resource settings, including sub-Saharan Africa (SSA). We hypothesized that a patient-centered integrated chronic disease model that included hypertension treatment and leveraged the HIV care system would reduce mortality among adults with uncontrolled hypertension in rural Kenya and Uganda. Methods and findingsThis is a secondary analysis of the SEARCH trial (NCT:01864603), in which 32 communities underwent baseline population-based multidisease testing, including hypertension screening, and were randomized to standard country-guided treatment or to a patient-centered integrated chronic care model including treatment for hypertension, diabetes, and HIV. Patient-centered care included on-site introduction to clinic staff at screening, nursing triage to expedite visits, reduced visit frequency, flexible clinic hours, and a welcoming clinic environment. The analytic population included nonpregnant adults ( ≥18 years) with baseline uncontrolled hypertension (blood pressure ≥140/90 mm Hg). The primary...
Source: PLoS Medicine - Category: Internal Medicine Authors: Source Type: research