Hypertension among persons living with HIV-Zambia, 2021; A cross-sectional study of a national electronic health record system

Jonas Z Hines; Jose Tomas Prieto; Megumi Itoh; Sombo Fwoloshi; Khozya D Zyambo; Suilanji Sivile; Aggrey Mweemba; Paul Chisemba; Ernest Kakoma; Dalila Zachary; Cecilia Chitambala; Peter A Minchella; Lloyd B Mulenga; Simon Agolory

doi:10.1371/journal.pgph.0001686

Hypertension among persons living with HIV-Zambia, 2021; A cross-sectional study of a national electronic health record system

PLOS Glob Public Health. 2023 Jul 10;3(7):e0001686. doi: 10.1371/journal.pgph.0001686. eCollection 2023.

Authors

Affiliations

¹ U.S. Centers for Disease Control and Prevention, Lusaka, Zambia.
² Palantir Technologies, Paris, France.
³ Ministry of Health, Lusaka, Zambia.
⁴ University of Zambia, School of Medicine, Lusaka, Zambia.

Abstract

Hypertension is a major risk factor for cardiovascular disease, which is a common cause of death in Zambia. Data on hypertension prevalence in Zambia are scarce and limited to specific geographic areas and/or populations. We measured hypertension prevalence among persons living with HIV (PLHIV) in Zambia using a national electronic health record (EHR) system. We did a cross-sectional study of hypertension prevalence among PLHIV aged ≥18 years during 2021. Data were extracted from the SmartCare EHR, which covers ~90% of PLHIV on treatment in Zambia. PLHIV with ≥2 clinical visits in 2021 were included. Hypertension was defined as ≥2 elevated blood pressure readings (systolic ≥140 mmHg/diastolic ≥90 mmHg) during 2021 and/or on anti-hypertensive medication recorded in their EHR ≤5 years. Logistic regression was used to assess for associations between hypertension and demographic characteristics. Among 750,098 PLHIV aged ≥18 years with ≥2 visits during 2021, 101,363 (13.5%) had ≥2 recorded blood pressure readings. Among these PLHIV, 14.7% (95% confidence interval [CI]: 14.5-14.9) had hypertension. Only 8.9% of PLHIV with hypertension had an anti-hypertensive medication recorded in their EHR. The odds of hypertension were greater in older age groups compared to PLHIV aged 18-29 years (adjusted odds ratio [aOR] for 30-44 years: 2.6 [95% CI: 2.4-2.9]; aOR for 45-49 years: 6.4 [95% CI: 5.8-7.0]; aOR for ≥60 years: 14.5 [95% CI: 13.1-16.1]), urban areas (aOR: 1.9 [95% CI: 1.8-2.1]), and on ART for ≥6-month at a time (aOR: 1.1 [95% CI: 1.0-1.2]). Hypertension was common among PLHIV in Zambia, with few having documentation of treatment. Most PLHIV were excluded from the analysis because of missing BP measurements. Strengthening integrated management of non-communicable diseases in HIV clinics might help to diagnose and treat hypertension in Zambia. Addressing missing data of routine clinical data (like blood pressure) could improve non-communicable diseases surveillance in Zambia.

Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Grants and funding

This research was financially supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) through a cooperative agreement with the Zambia Ministry of Health (NU2GGH002234-02) and a grant from the National Institutes of Health to Palantir Technologies (75N95021F00005). Palantir Technologies provided support in the form of salary for JTP. The specific role of this author is articulated in the ‘author contributions’ section. No additional external funding was received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.