Outcomes of the healthy heart Africa program on management of hypertensive patients in Nairobi county, Kenya.

Abstract

Background: Hypertension is an independent risk factor for developing cardiovascular and renal diseases worldwide. Hypertensive patients in Sub-Saharan Africa have low hypertension awareness, treatment levels and control. In response to these problems, AstraZeneca, a British Swedish Pharmaceutical Company, introduced the Healthy Heart Africa program which it implements in partnership with AMREF Health Africa in Nairobi. Study objective: To compare the management and treatment outcomes of hypertensive patients enrolled into the Healthy Heart Africa (HHA) program and their unenrolled counterparts. Method: The study was carried out at two HHA program implementation sites in Kibera slum i.e. Kibera Community Health Center and Karen Health Center. The comparison population was drawn from Dandora Phase 1 and 2 Health Centers. This study was conducted in two phases. The first phase that was quantitative adopted a retrospective cohort study approach whereby hypertensive patients who met the eligibility criteria were identified. A designed, pre-tested and modified Data Collection Form was used for collecting patient information including sociodemographic and clinical characteristics, BP readings and all prescribed medicines and the respective dosages. The primary outcome was adequacy of controlled blood pressure. The second phase was a qualitative research design that employed patient interviews that were used in assessing the level of adherence to treatment among the hypertensive patients. Prescribers and key informants were also interviewed to elicit information on aspects of management of patients as well as the challenges experienced in the adoption and implementation of the program. Quantitative data was analyzed descriptively using measures such as frequencies, percentages, mean and standard deviation. Two-sample t-test analysis were used to establish whether the mean and median BP of the patients at the two study groups were significantly different. The strength of association between adherence score and level of blood pressure was obtained using linear regression. Multiple logistic regression analysis was used to establish the independent relationship between adequacy of BP control and selected predictor variables of the study. The level of significance was set at 0.05. A descriptive thematic approach was used to analyze the qualitative data, whereby the data was examined; key and meaningful themes/patterns were identified and interpreted by triangulation of all the provided information. Approval to carry out the study was granted by Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (KNH/UoN-ERC). Results: Of the 265 patients screened over a 6 months’ period, 250 (91%) met the inclusion criteria and 205 were recruited; 58.5% were female; mean age was 54 years; mean duration of hypertension management was <2 years. Seventy-eight (72%) patients enrolled in HHA had adequate BP control compared to forty-two (43%) in the non-HHA sites after 6 months of treatment. Seventy (34.1%) of the patients were fully adherent to medication. Patients in the HHA (OR 2.6 95% CI 1.5, 4.6; p <0.001) had their BP better controlled compared to their unenrolled counterparts. Adherence to medication (OR 0.87 95% CI 0.8, 0.9; p<0.001) significantly contributed to BP control. Conclusion: Patients managed at the HHA enrolled facilities had their Blood pressure levels adequately controlled compared to those in non-HHA health facilities. These patients were also observed to be highly adherent to their antihypertensive therapy. Adherence to antihypertensive therapy and patient’s level of education were predictors of adequate BP control. Programs similar to HHA should be designed and scaled up to cover numerous facilities so that large numbers of patients benefit. A prospective study on hypertension treatment outcomes and adherence should also be conducted.