Screening & management of hypertension among People Living with HIV (PLHIV) through 'single window approach': aexperience from ART Centers in Mumbai, India

BACKGROUND: Non-communicable diseases (NCD) including hypertension are the leading cause of mortality both globally and in India. HIV-infected adults on ART have a higher prevalence of hypertension when compared with HIV-uninfected individuals. People Living with HIV (PLHIV) with hypertension also have a higher risk of cardiovascular events and all-cause mortality. Though longevity in PLHIV has increased with ART, there is hardly any information on NCDs or its management among PLHIVs in India. It was decided to launch a pilot project for integrated hypertension and ARV services through ART centers in Mumbai.
DESCRIPTION: A standardized Protocol for Screening and Management of Hypertension was developed through the expert committee to avoid drug-drug interactions, reduce pill burden and improve medication adherence for PLHIVs. The training was conducted for different cadres of ART Center staff with a focus on integrating the process of screening and treatment with existing patient flow strategies and defined roles & responsibilities for staff. Screening for all adult PLHIVs has been initiated during their routine visit at ART Center with appropriate treatment for patients diagnosed with hypertension. Referral for patients with severe hypertension and other complications has also been initiated.
LESSONS LEARNED: Routine screening for hypertension has helped in early diagnosis and treatment initiation among PLHIVs across all ART centers in the city. To date 25758 adult PLHIV registered for care have been screened for hypertension and 3948 (15.3%) have been put on anti-hypertensive medicines through ART centers.55% were males while 45% were females. The commonest age group was between 35 to 45 years of age.
CONCLUSIONS: NCD screening can be integrated into HIV care through standardized screening and management protocol. The early detection and management of hypertension and other NCDs among PLHIVs at ART Centres can help in reducing morbidity & mortality. This model for integrated services can be scaled up at all ART centers across the country.