Incidence and predictors of hypertension and hypertension treatment success among adults on ART in Blantyre and Zomba, Malawi
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Date
2022-06-09
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Kamuzu University of Health Sciences
Abstract
Type of study: It is retrospective cohort study design embedded in a large
randomized controlled clinical trial that recruited and followed HIV positive adults on ART from
November 2012 to July 2018 in Blantyre and Zomba.
Problem: People living with human immunodeficiency virus (PLHIV) are at increased risk of
premature deaths due to cardiovascular diseases (CVD) compared to the general population
because of additional HIV specific factors and exposure to antiretroviral therapy (ART) (1).
Results from a cross-sectional study done by Dimala et.al (2016) demonstrated that
hypertension is more prevalent in people on ART compared to ART naïve population (2). Few
studies that have been conducted in sub-Saharan Africa (SSA) to understand the incidence
and risk factors of hypertension in PLHIV, have reported conflicting results (3–5). Some
studies have reported low incidence of hypertension (3) while other studies have reported
high incidence of hypertension (4,5). In Malawi there is limited data regarding incidence of
hypertension, risk factors of hypertension and factors that are associated with hypertension
control. These gaps are very concerning in PLHIV given that this population is currently
experiencing dual burden of infections and non-communicable diseases (NCD) (6). Thus, this
study seeks to determine the incidence and risk factors of hypertension and factors that are associated with hypertension treatment control in adults on ART. The results from this study
will provide knowledge to enhance equitable allocation of resources by the ART managers. If
the managers know and understand the burden of hypertension and factors related to
treatment success, they can retrain their staff and provide BP machines in ART clinics for the
health care workers to routinely screen PLHIV for hypertension. Additionally, if we find high
nonadherence to hypertensive treatment due to pill burden, we will advocate for antihypertensive
treatment with a single pill combination (SPC) of two drugs along with appropriate lifestyle interventions.
Objectives:
The broad objective of this study is:
• Too determine the incidence of hypertension among adults on ART in Blantyre and
Zomba, Malawi between 2012 and 2018.
The specific objectives are:To determine the prevalence of hypertension (Systolic BP ≥140mmHg, Diastolic BP
≥90mmHg) among PLHIV on ART screened between November 2012 and July 2018 in
Zomba and Blantyre, Malawi
• To determine the risk factors of hypertension among adult PLHIV on ART screened
between 2012 and July 2018 in Zomba and Blantyre, Malawi.
• To determine the risk factors for developing hypertension among adult PLHIV stable on
ART and followed up between November 2012 and July 2018 in Zomba and Blantyre,
Malawi
• To determine the risk of uncontrolled hypertension among hypertensive PLHIV stable
on ART who were recruited and followed up between November 2012 and July 2018 in
Zomba and Blantyre, Malawi
• To determine predictors of poor hypertension control among adult PLHIV stable on
ART and followed up between November 2012 and July 2018 in Zomba and Blantyre,
Malawi. Methodology: This is a retrospectiveprospective study design using data from a large
randomized controlled clinical trial that was conducted from November 2012 to July 2018
which recruited HIV infected adults on ART in Blantyre at Blantyre Malaria Project (BMP),
Ndirande Research Clinic and in Zomba at Dignitas International, Tisungane Research Clinic.
Data was handed over to the Principal Investigator in an excel format. In the secondary
analysis, we will extract data to the workable excel sheet before analysis. The sample size of
307 is ideal for this study, however, to ensure that our sample is well representative, we will
analyze all 2, 237 screened participants and 1, 499 enrolled participants from the parent
study.
Expected findings and dissemination: This study will provide information on how many
people develop hypertension in PLHIV on ART. This will eventually assist government to plan
equitable allocation of resources to PLHIV on ART to mitigate hypertension. The study willalso provide information on whether it is time to advocate for one Single Pill Combination
(SPC) for hypertension as the means to address pill burden which result in poor adherence of
antihypertensives in PLHIV on ART. This will ensure that PLHIV on ART are able to control
hypertension and live healthy life and able to participate in developmental activities in their
communities. Results from this study will be presented at the College of Medicine Research
Hypertension in PLHIV Version 3.02.0, 11 May12 March 2022 Page 8 of 26
Dissemination Conference and other international fora. We will also share the results with
College of Medicine Research and Ethics Committee (COMREC) and the Ministry of Health in
Malawi, NCD department. We will prepare a manuscript for a peer reviewed journal
publication.
Description
Type of study: It is retrospective cohort study