Martin Muddu, MBChB, MMed

GHES LMIC Fellow 2017-2018

Home Institution: Makerere University, Kampala, Uganda
US Institution: Yale University

Project Title: Integrating management of hypertension into HIV programs in Uganda

Sub-Saharan Africa (SSA) is undergoing an epidemiological transition that includes an epidemic of hypertension (HTN) with prevalence in Uganda of 26.4%. Persons living with HIV are increasingly affected by HTN and risk of cardiovascular disease, both because of increased survival made possible by antiretroviral therapy (ART) and by direct effects of ART itself.

The Ugandan health care system, similar to many low- and middle-income countries, is under-resourced to be able to adequately address this double burden of HIV and HTN, as well as other highly prevalent communicable and non-communicable diseases. Efforts are underway in Uganda to integrate TB, Malaria, Nutrition, Maternal/child health and family planning into HIV programs. However, health services for chronic non-communicable diseases (NCDs) such as HTN remain fragmented and not integrated into these other existing programs. Herein represents a major opportunity for enhancing health delivery for patients with multiple chronic conditions such as HIV and HTN- an opportunity supported by existing literature. Programs for HIV and HTN remain vertically oriented, meaning that these two chronic conditions are typically addressed in different clinical settings and care for the patients affected by both is not integrated. Vertical programs are often associated with poor client retention, increased morbidity, mortality, high cost and are neither patient-centered nor empowering. This situation poses a major threat to fragile health systems and emphasizes the need for innovative integrative approaches to health services.

In the current implementation science study, guided by the Consolidated Framework for Implementation Research (CFIR) and the PRECEDE-PROCEED Models for Implementation Science Research, we propose to integrate the standard management of hypertension with HIV management along the whole continuum of services for HIV in 3 ART clinics of Tororo District in Eastern Uganda. In this study we will build upon the prior experience of the Uganda Initiative for Integrated Management of Non-Communicable Diseases and Ministry of Health (MOH) in training healthcare providers on integrated care of patients with chronic conditions.

The integrated approach is anticipated to: increase access to treatment by allowing for single visits for both diseases, maximize efficiency of the limited human resources for health, result in positive clinical outcomes for patients with both conditions, increase the number of HIV facilities that can offer hypertension management in Uganda and reduce the cost, morbidity and mortality due to hypertension and HIV.