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Publication: Multilevel predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in rural South Africa: A panel study
Ameh, S. Gómez-Olivé, F.X. Kahn, K. Tollman, S. Klipstein-Grobusch, K.
Ameh, S.
Gómez-Olivé, F.X.
Kahn, K.
Tollman, S.
Klipstein-Grobusch, K.
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Abstract
Objective: In 2011, The National Department of Health introduced the Integrated Chronic Disease Management (ICDM) model as a pilot programme in selected primary healthcare facilities in South Africa. The objective of this study was to determine individual-level and facility-level predictors of controlled CD4 count and blood pressure (BP) in patients receiving treatment for HIV and hypertension, respectively.
Design: A panel study.
Setting and participants: This study was conducted in the Bushbuckridge Municipality, South Africa from 2011 to 2013. Facility records of patients aged ≥18 years were retrieved from the integrated chronic disease management (ICDM) pilot (n=435) and comparison facilities (n=443) using a three-step probability sampling process. CD4 count and BP control are defined as CD4 count >350 cells/mm3 and BP <140/90 mm Hg. A multilevel Least Absolute Shrinkage and Selection Operator binary logistic regression analysis was done at a 5% significance level using STATA V.16.
Primary outcome measures: CD4 (cells/mm3) count and BP (mm Hg).
Results: Compared with the comparison facilities, patients receiving treatment in the pilot facilities had increased odds of controlling their CD4 count (OR=5.84, 95% CI 3.21-8.22) and BP (OR=1.22, 95% CI 1.04-2.14). Patients aged 50-59 (OR=6.12, 95% CI 2.14-7.21) and ≥60 (OR=7.59, 95% CI 4.75-11.82) years had increased odds of controlling their CD4 counts compared with those aged 18-29 years. Likewise, patients aged 40-49 (OR=5.73, 95% CI 1.98-8.43), 50-59 (OR=7.28, 95% CI 4.33-9.27) and ≥60 (OR=9.31, 95% CI 5.12-13.68) years had increased odds of controlling their BP. In contrast, men had decreased odds of controlling their CD4 count (OR=0.12, 95% CI 0.10-0.46) and BP (OR=0.21, 95% CI 0.19-0.47) than women.
Conclusion: The ICDM model had a small but significant effect on BP control, hence, the need to more effectively leverage the HIV programme for optimal BP control in the setting.
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Date
2020-11-03
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BMJ
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Keywords
Epidemiology,HIV & AIDS,Hypertension,Public health
Citation
Ameh S, Gómez-Olivé FX, Kahn K, Tollman S, Klipstein-Grobusch K. Multilevel predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in rural South Africa: a panel study. BMJ Open. 2020 Nov 3;10(11):e037580. doi: 10.1136/bmjopen-2020-037580