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Walsh KF, Lee MH, Martelly S, Pierre MM, Joseph J, Gustin M, Peck RN, Fitzgerald DW, Pape JW, McNairy M. Integrating hypertension services at an HIV clinic in Port-au-Prince, Haiti: A report from the field. J Clin Hypertens (Greenwich) 2018; 20:1485-1492. [PMID: 30259642 DOI: 10.1111/jch.13392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/05/2018] [Accepted: 07/15/2018] [Indexed: 01/01/2023]
Abstract
HIV-positive adults with hypertension have increased risk of mortality but HIV clinics often do not provide hypertension care. The authors integrated hypertension management into existing HIV services at a large clinic in Haiti. Of 1729 documented HIV-positive adults presenting for care at the GHESKIO HIV clinic between March and July 2016, 551 screened positive for hypertension, with systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. A convenience sample of 100 patients from this group received integrated hypertension and HIV care for 6 months. At time of identification, patients were screened for proteinuria and initiated on antihypertensive medication. Hypertension and HIV visits coincided; medications were free. Outcomes were retention in care and change in blood pressure over 6 months. Average blood pressure over 6 months was described using linear mixed-effects model. Of 100 HIV-positive adults with hypertension referred for integrated care, three were ineligible due to comorbidities. Among 97 participants, 82% (N = 80) remained in care at 6 months from time of positive hypertension identification. 96% (N = 93) were on antiretroviral therapy with median CD4+ count of 442 cells/µL (IQR 257-640). Estimated average blood pressure over 6 months decreased from systolic 160 mmHg (CI 156, 165) to 146 mmHg (CI 141, 150), P-value <0.0001, and diastolic 105 mmHg (CI 102, 108) to 93 mmHg (CI 89, 96), P-value <0.0001. HIV and hypertension management were successfully integrated at a HIV clinic in Haiti. Integrated management is essential to combat the growing burden of cardiovascular disease among HIV-positive adults.
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Affiliation(s)
- Kathleen F Walsh
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York City, New York
| | - Myung Hee Lee
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York City, New York
| | - Shoria Martelly
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Marie Melissa Pierre
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Junon Joseph
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Myrlene Gustin
- The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Robert N Peck
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York City, New York
| | - Daniel W Fitzgerald
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York City, New York
| | - Jean William Pape
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York City, New York.,The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Margaret McNairy
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York City, New York
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