Could treating high blood pressure and diabetes become a standard part of HIV care?

In East Africa, ‘one-stop’ clinics for people with HIV, hypertension or diabetes, or a combination of these conditions, have been trialled.  

What is the research about? 

Providing integrated care for hypertension (high blood pressure), diabetes and HIV for people in Tanzania and Uganda. Ten one-stop care clinics were set up in primary healthcare facilities. People could enrol in the study and use the clinics if they had one or more of the three conditions.  

Just under 2,300 people participated in the study. People with more than one condition received care for their conditions in the same appointment. Initially, people were followed for between 8-12 months. But the study was extended due to COVID-19, and people were given the option of continuing for up to 24 months.  

Why is this research important? 

In Africa, 1 in 4 adults have hypertension, and 1 in 22 adults have diabetes. Around 2 million adults die on the continent each year due to the two conditions, and deaths are rising.  

Africa also remains at the centre of the HIV pandemic. Currently, HIV care is provided from relatively well-resourced clinics, and around 90% of people diagnosed with HIV in Africa are in regular care. In contrast, hypertension clinics and diabetes clinics are non-existent or poorly resourced. As a result, only around 10% of people with hypertension or diabetes are in regular care.  

Combining services for the three conditions could help to ease the pressure on health systems. It could also improve hypertension and diabetes care for patients. It is particularly important to understand whether HIV care could suffer if hypertension and diabetes services were integrated and given similar resourcing.  

What did they find out? 

After eight months, 85% of participants were still in care. Among these, just under 70% enrolled for the extended study. Most of these people (96%) stayed in integrated care until the end of the study. 

The mean age of people who stayed in the study was 51. Around 40% had multiple conditions. Of these, 19% had diabetes and hypertension, 15% had HIV and hypertension, 2% had HIV and diabetes, and 4% had all three conditions. 

At the end of the study, 54% of people with hypertension had blood pressure that was under control, 32% of people with diabetes had blood sugar that was under control, and 97% of people with HIV were virally suppressed.  

What does this mean for HIV services? 

The one-stop clinics were successful at keeping people in long-term care. This is essential for any healthcare to be effective because a service cannot succeed if attendance levels are poor. The one-stop clinic was particularly popular with older people and those with multiple conditions. 

In terms of health outcomes, the HIV care provided resulted in a high viral suppression rate, as would be expected. The model was less successful at controlling hypertension and diabetes. But it was still more effective than the current system in both countries in which hypertension and diabetes care is provided separately and is often limited. Further research is needed on how to improve people’s adherence to hypertension and diabetes medications, including how to improve the dosing strategies for both conditions and the supply of medicines. 

The move to more integrated healthcare is likely to be a sign of things to come, as more governments look to treat chronic, long-term conditions amid limited, or even shrinking, resources.