Prevalence of and Risk Factors for Hypertension Among Hiv-positive Women of Reproductive Age on Antiretroviral Therapy in Meru County, Kenya

Abstract

Background: The introduction of antiretroviral therapy (ART) in Kenya has improved the life expectancy for persons living with HIV. However, the emergence of non-communicable chronic diseases such as hypertension is threatening the gains made in reducing morbidity and mortality from HIV-related complications. Evidence shows that hypertension and associated adverse health outcomes is common among HIV-infected adults on ART in Kenya. Despite the increasing burden of hypertension in HIV-positive patients, there is still insufficient understanding of its prevalence and risk factors particularly among HIV-infected women of reproductive age (WRA) on ART in Kenya. Objective: To estimate the prevalence of hypertension and assess the associated risk factors in HIV-positive WRA on ART in Meru County, Kenya. Methodology: This was a health facility-based cross-sectional study. The study was conducted in three health facilities in Meru County, Kenya. The selected facilities include, Meru Teaching and Referral Hospital (MeTRH); Consolata Hospital Nkubu; and Maua Methodist Hospital. The study involved 310 participants identified using repeated systematic sampling technique. Data were collected through interviewer-administered questionnaires, physical measurements and a review of patient health records. Data collection took 47 days between September 2021 and January 2022. Data were entered, cleaned, coded, stored, and analysed using version 25 of the Statistical Package for Social Sciences (SPSS) software. Both descriptive and inferential statistics were used for data analysis. Frequency tables were used to describe the sociodemographic characteristics of the study population. Bi-variable and multivariable logistic regression analyses were used to examine the risk factors for hypertension among the study population. xvi Results: The prevalence of hypertension was 23.9% (95% CI: 19.2 – 29.0; p < 0.001). This means that six in 25 WRA on ART in Meru County were hypertensive. Bivariable logistic regression analysis showed that older age, ever use of contraceptives, having a family history of hypertension, and abdominal obesity (WHR≥0.85) had statistically significant positive association with the risk of hypertension (crude odds ratio [COR] = 2.84, 95% CI: 1.53-5.30, for those who were 35-49 years old compared to the 18-34 years old; COR = 3.05, 95% CI: 1.05-8.88; COR = 3.29, 95% CI: 1.92-5.65; and COR = 1.77, 95% CI: 1.01-3.09, respectively). Non-statistically significant positive associations were observed between hypertension and longer duration since HIV diagnosis (p <0.38), longer duration on ART (p< 0.33) and being on highly active ARVs (p < 0.17). Multivariable logistic regression analysis indicated that participants who had ever smoked cigarettes had a statistically significant higher risk of hypertension relative to never smokers (adjusted odds ratio [AOR] = 12.537, 95% CI: 2.369-66.344). A weaker, non-statistically significant association was observed in the bivariable analysis. Participants who were overweight (BMI = 25.0-29.9 kg/m2) had a statistically significant positive association with the risk of hypertensive relative to those who were of normal weight (AOR = 6.69, 95% CI: 2.78-16.09). Obesity (BMI ≥30.0 kg/m2) was associated with a non-statistically significant higher risk of hypertension (AOR = 1.39, 95% CI: 0.48-4.03). A positive association between obesity and hypertension was also observed in the bivariable analysis. Participants who had a family history of hypertension had a fourfold higher risk of hypertension (AOR = 4.46, 95% CI: 2.04 – 9.75). A threefold higher risk of hypertension among those with a family history of hypertension was observed in bivariable analysis. xvii Conclusion: The findings show that the prevalence of hypertension among WRA on ART is similar to the global estimates of the risk of hypertension among PLWHIV on ART and that of the general adult population in Kenya. Cigarette smoking, being overweight, and having a family history of hypertension were associated with the risk of hypertension among the study population. The study findings provide a firm basis for the integration of regular screening and management of hypertension and associated risk factors into the routine HIV and AIDS care for improved health and survival of HIV-positive patients especially WRA on ART. The current evidence provides critical information that could inform the implementation of relevant policies, strategies and guidelines in the Country such as the Kenya Health Policy 2014-2030, Kenya Community Health Policy 2020-2030, the 2018 Kenya National Guidelines for Cardiovascular Diseases Management, and the 2016 Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV Infections in Kenya. Early diagnosis, prevention and control of hypertension and associated adverse health outcomes would significantly improve not only the quality of life for the HIV-positive patients but also that of the general population.