Representatives from the iHEART-SA research team in May of 2024. PHOTO: RCC/April Houston.
As the global public health community reflects on how far we have come and how far we have left to go in the fight against HIV/AIDS on this World AIDS Day, the HLB-SIMPLe Alliance is spotlighting challenges that tend to overlap with HIV, particularly hypertension and cardiovascular disease. As we have explained before, people living with HIV (PLHIV) are at a heightened risk of developing high blood pressure due to a combination of aging, socioeconomic stressors, and side effects of the medications they take to manage their HIV. Unfortunately, routine blood pressure checks are not often given at HIV clinics in low-resource environments, which is where many PLHIV access health services, especially in Africa.
South Africa remains at the epicenter of the HIV epidemic, hosting the world’s largest population of people living with the virus. Over 20% of global HIV cases are in South Africa, and while antiretroviral therapy (ART) has made remarkable strides in reducing AIDS-related deaths, the challenge of non-communicable diseases, such as hypertension, persists.
A recent study from our iHEART-SA team, published in Implementation Science Communications, offers new insights into the factors affecting the management of hypertension among people living with HIV in South Africa. Researchers interviewed and held discussions with clinic staff, managers, and patients to understand the challenges and needs for better managing hypertension alongside HIV care. The responses highlighted key factors that affect the way hypertension care is delivered, such as knowledge, support, and social and environmental influences that impact patients’ engagement with care.
Study Findings: Barriers to Hypertension Care
The study identifies several systemic and individual barriers to hypertension care among PLHIV. Key findings include:
- Healthcare system limitations. Providers at HIV clinics often prioritize HIV treatment over comprehensive care, leading to missed opportunities for early diagnosis and treatment of hypertension. Staff and managers interviewed for the study reported that they regularly must contend with personnel shortages and a lack of medical resources, making it difficult to consistently offer hypertension screening and treatment to their patients.
- Inconsistencies in training for providers. Clinic staff noted that inconsistent training on chronic care guidelines hinders routine hypertension screening and treatment in clinics. Many emphasized that regular training across all roles, from clinicians to community health workers, would help to ensure effective implementation and support task-shifting during staff shortages.
- Patient motivations and frustrations. Most of the patients who participated in the study reported that they were motivated to manage their hypertension so they would reduce their risk for experiencing hypertension-related adverse health outcomes. Participants also reported wanting to stay healthy to avoid having to go to the clinic, which many felt to be burdensome and stressful. As explained in the Implementation Science Communications article, “nearly all patients described clinics as unorganized (e.g., lost files, inconsistent blood pressure screenings) and inadequate in terms of staffing and resources (e.g., broken blood pressure machines).”
Why Integration Matters
Leslie Johnson, assistant professor at Emory University and lead author of the study underscores that in spite of the barriers identified by the research team the data also illuminate opportunities to strengthen care for people living with HIV and comorbidities. “Despite the challenges, there was strong support among clinical actors for combining HIV and hypertension care,” she explained in a commentary accompanying the original article. “Our team aims to overcome challenges at the patient, provider, and clinic-level that may hinder improved cardiovascular disease control in this high-risk population.”
The study serves as a crucial reminder that addressing HIV-related health challenges requires a multifaceted approach and person-centered care. As we commemorate World AIDS Day, let us commit to comprehensive healthcare systems that treat PLHIV as whole individuals with diverse needs.
Read more about this critical study and its implications here and the accompanying commentary here.