Joseph (not real name) had been receiving HIV treatment from Mulago ISS clinic for eight years. He was regular and seldom missed his once-a-month appointment to receive his anti-retroviral treatment (ART) at Uganda’s largest HIV clinic. As part of routine screening, Joseph was shocked when he was diagnosed with high blood pressure (hypertension) last year. His doctor referred him to another clinic for treatment of hypertension because ISS clinic did not have adequate supply of medicines for hypertension. Naturally, Joseph was disappointed. It meant that he had to take another day off work to seek treatment for hypertension. After 8 years of receiving comprehensive HIV treatment at Mulago ISS clinic, he was reluctant to go to another clinic. Consequently, he ignored his doctor’s advice to seek hypertension treatment elsewhere.
Joseph’s story is not an isolated case. About 20% of the adults living with HIV that receive treatment at the MJAP’s Mulago ISS clinic are hypertensive too. At the national level, about 25% of adults in Uganda have hypertension. The burden is even higher among adult persons living with HIV on ART, where the numbers are as high as 29%.
Hypertensive people living with HIV often receive services for hypertension and HIV in separate clinics. This leads to undiagnosed and untreated hypertension among people living with HIV due to the time, costs and stigma that comes with seeking treatment from multiple clinics. This approach is not patient centered, is costly and inefficient for both HIV and hypertension control.
Studies have shown that an integrated approach to treatment of HIV and hypertension improves hypertension control among people living with HIV. With funding from Resolve to Save Lives, Makerere University Joint AIDS Programme (MJAP) is now providing integrated HIV and hypertension care at the Mulago ISS clinic through the LINKS project. LINKS is an online community and resource-sharing platform that connects people working to improve cardiovascular health around the world.
In the first year of implementation, over 16,000 people receiving treatment from the clinic have been screened for and 10.5% were diagnosed with hypertension. Through a partnership with Novartis Access which is providing quality hypertension treatment to MJAP at a subsidized cost, people living with HIV diagnosed with hypertension will start receiving hypertension treatment at the clinic in August 2019 at no cost, making MJAP’s Mulago ISS clinic the first one-stop center for HIV and hypertension treatment in Uganda.
When we met Joseph again in the last week of July 2019, he was not as crestfallen as the previous year when he had first learned about the diagnosis of hypertension. He, alongside seven other people living with HIV and hypertension, had come for a focus group discussion to deliberate on how MJAP can make integrated hypertension/HIV services more patient-centered. He was glad to share his experience and ideas.
“I am glad I do not have to ask my supervisors for another day off work to get treatment for hypertension. Also, starting to explain to a new doctor about my condition is something I was not comfortable to do. The doctors here understand my medical history and I am happy that both my HIV and hypertension conditions shall be effectively managed from here,” Joseph said.
In the last week of July, 2019, Dr. Tom Frieden, President and CEO of Resolve to Save Lives and Ms. Robynn Leidig, Manager, Strategic Initiatives visited the ISS clinic in Mulago to assess the progress of the project and observe the project in action. After a guided tour of the clinic, they held a meeting with the MJAP team, and officials from the Uganda Heart Institute, US Centers for Disease Control and Prevention and the Uganda Ministry of Health.
“I am impressed by the electronic record-keeping which ensures that you are able to retrieve all clients’ information in real-time,” Dr. Frieden said. “This is in line with our ambition to ensure that all our programs demonstrate simplicity, speed, scalability, and sustainability,” he added.
At the meeting, Prof Moses Kamya, Chairman of the Board of Directors at MJAP and also the Dean School of Medicine, Makerere University College of Health Sciences, reiterated MJAP’s commitment to exploring new ways to simplify hypertension treatment among people living with HIV.
“We are looking at task-shifting. We are equipping all nurses and clinical officers with the skills they need to manage hypertension in stable patients while the complicated cases will be managed by the doctors. That way, we shall have our clients receive excellent services while managing the time they spend in the clinic,” Prof. Kamya said.
“We are counting on the success of this project to explore better ways in which integrated HIV and hypertension care can be scaled up in all our clinics; and hopefully across all HIV clinics in the country,” Prof. Kamya reiterated.