J Clin Hypertens. 2018;20:1485–1492. wileyonlinelibrary.com/journal/jch
|
1485 ©2018 Wiley Periodicals, Inc.
1 | INTRODUCTION
Hypertension is a leading risk factor for cardiac disease contrib‐
uting to 9.4 million deaths annually
1
and an independent predic‐
tor of mortality among HIV‐positive adults.
2
Hypertension may
be more prevalent among HIV‐positive individuals,
3,4
due to an‐
tiretroviral use or because the virus itself is a risk factor for car‐
diovascular disease.
5,6
In many resource‐limited settings, HIV and
hypertension are managed separately without communication
between providers.
Haiti is the poorest country in the western hemisphere.
7
HIV
prevalence in Haiti is 1.7% among adults, the highest in the Caribbean
and Latin America.
8
HIV‐positive individuals in Haiti with access to
antiretroviral therapy (ART) are living longer, with 10‐year survival
rates exceeding 60%.
9
National prevalence data of hypertension in
Haiti are lacking but estimates suggest it is common.
10‐12
Received: 30 April 2018
|
Revised: 5 July 2018
|
Accepted: 15 July 2018
DOI: 10.1111/jch.13392
ORIGINAL PAPER
Integrating hypertension services at an HIV clinic in Port‐au‐
Prince, Haiti: A report from the field
Kathleen F. Walsh MD
1
| Myung Hee Lee PhD
1
| Shoria Martelly MD
2
|
Marie Melissa Pierre MD
2
| Junon Joseph MD
2
| Myrlene Gustin RN
2
| Robert N. Peck
MD
1
| Daniel W. Fitzgerald MD
1
| Jean William Pape MD
1,2
| Margaret McNairy MD
1
1
Center for Global Health, Department of
Medicine, Weill Cornell Medicine, New York
City, New York
2
The Haitian Group for the Study of Kaposi's
Sarcoma and Opportunistic Infections
(GHESKIO), Port‐au‐Prince, Haiti
Correspondence
Kathleen F Walsh, Center for Global Health,
Department of Medicine, Weill Cornell
Medicine, New York City, NY.
Email: kfw2001@med.cornell.edu
Funding information
Fogarty International Center, Grant/
Award Number: R25 TW009337; National
Institutes of Health, USA
Summary
HIV‐positive adults with hypertension have increased risk of mortality but HIV clinics
often do not provide hypertension care. The authors integrated hypertension man‐
agement 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 initi‐
ated on antihypertensive medication. Hypertension and HIV visits coincided; medi‐
cations 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 in‐
tegrated care, three were ineligible due to comorbidities. Among 97 participants,
82% (N = 80) remained in care at 6 months from time of positive hypertension iden‐
tification. 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 de‐
creased 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.