Multilevel Predictors of Controlled CD4 Count and Blood Pressure in an Integrated Chronic Disease Management Model in Rural South Africa: a Panel Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2020 Nov 5

PMID 33148729

Citations 1

Authors

Soter Ameh

Francesc X Gomez-Olive

Kathleen Kahn

Stephen Tollman

Kerstin Klipstein-Grobusch

Affiliations

Soon will be listed here.

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/mm 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/mm) 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.

Citing Articles

Multimorbidity and mortality in an older, rural black South African population cohort with high prevalence of HIV findings from the HAALSI Study.

Wade A, Payne C, Berkman L, Chang A, Gomez-Olive F, Kabudula C BMJ Open. 2021; 11(9):e047777.

PMID: 34526338 PMC: 8444254. DOI: 10.1136/bmjopen-2020-047777.

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