Article Text

Original research
Multilevel predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in rural South Africa: a panel study
  1. Soter Ameh1,2,3,
  2. Francesc X Gómez-Olivé2,4,
  3. Kathleen Kahn2,4,5,
  4. Stephen Tollman2,4,5,
  5. Kerstin Klipstein-Grobusch6,7
  1. 1Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
  2. 2Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  3. 3Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
  4. 4The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), Accra, Ghana
  5. 5Umeå Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden
  6. 6Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  7. 7Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr Soter Ameh; sote_ameh{at}yahoo.com

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.

  • hypertension
  • epidemiology
  • hiv & aids
  • public health
  • epidemiology
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Footnotes

  • Funding This work was supported by the Agincourt Health and Socio-Demographic Surveillance System, a node of the South African Population Research Infrastructure Network (SAPRIN) and is supported by the National Department of Science and Innovation, the Medical Research Council and the University of the Witwatersrand, South Africa, and the402 Wellcome Trust, UK (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z;403 085477/B/08/Z); Fogarty International Centre of the National Institutes of Health [D43404 TW008330]; and African Doctoral Dissertation Research Fellowship Programme award to the corresponding author. Funding for the article processing charge for this manuscript was provided by the Lown Scholars Program in Cardiovascular Health, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical clearance for this study was received from the Committee for Research on Human Subjects (Medical) of the University of the Witwatersrand, Johannesburg, South Africa (Ref No. M120943), and the Mpumalanga Provincial Research and Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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