Addressing gaps in healthcare providers’ knowledge, attitudes, and practices to establish a sustainable model for integrated HIV- hypertension care in Uganda

Abstract

<title>Abstract</title> Background Despite the available guidelines to integrate HIV and hypertension (HTN) care in Uganda, access to quality HTN care is still limited to a few tertiary HIV clinics. We explored the current state of HTN care in HIV settings, understand healthcare providers’ (HCP) knowledge, attitudes and practices regarding HTN care, as well as the perceptions of HCPs, healthcare managers and policymakers about integrated HIV-HTN care. The goal was to use this formative research to inform the design of a sustainable, robust model for integrating HIV-HTN care in primary health care (PHC) HIV clinics in urban and peri-urban areas of Uganda Methods We conducted a parallel convergent mixed methods study at ten HIV clinics in Kampala and Wakiso districts. We consecutively surveyed 89 HCPs involved in the provision of routine HIV care to assess their knowledge, attitudes and practices towards HTN care. We purposively selected 40 HCPs and 6 healthcare managers to participate in semi-structured key informant interviews (KII). Interviews were audio recorded and later transcribed. Through an iterative process, the data was deductively coded and the final codes were mapped onto the domains of the updated Consolidated Framework for Implementation Research (CFIR). Quantitative data was analysed in Stata 14. Categorical data were summarized using proportions and frequencies, while median and interquartile ranges were used for continuous data. The data was stratified by district. Results Between June 2021 and November 2021, 89 HCPs (45-Kampala, 44-Wakiso) median age of 35 (IQR, 29–45) years, and 62% of them were female participated in the survey. HCPs reported no in-service training on HTN, had insufficient knowledge on HTN, limited access to simplified protocols for the treatment of HTN, and reported varying levels of HIV-HTN integration across the ten clinics. HCPs reported a lack of sufficient numbers of functional blood pressure (BP) devices, anti-hypertensive medicines, lack of reporting tools and feedback regarding HTN care metrics as the major hindrances to provision of integrated HIV-HTN care. Despite these hindrances, HCP expressed willingness to integrate HIV-HTN care to reduce client waiting time, costs, and HCP workload. Conclusions This formative assessment identified gaps in current HTN care in HIV clinics in urban and peri-urban Uganda. This provided a context to inform the design of a sustainable, robust and sustainable model for integrating HTN and HIV-HTN care in PHC HIV clinics in urban and peri-urban areas of Uganda.