Determinants of Hypertension Among Hiv Positive Patients at Mathare North Health Center, Nairobi

Abstract

The double burden of both non-communicable and communicable conditions is becoming a reality in developing counties. Changes in lifestyle patterns and longer survival rates in HIV positive patients have led to an increased risk of developing non-communicable diseases like hypertension and other cardiovascular conditions. Hypertension contributes to a greater extend of the heart disease, which may be led to increased rate of sickness and death in HIV positive patients. High blood pressure in Kenya has been on the increase based on data from studies. Available data shows an increase in the prevalence of hypertension in people living with HIV in Kenya, but the research was done in tier three and four health facilities. It is not known if the prevalence and distribution of determinants is similar to that in the tier 2 facilities. Tier two health facilities like Mathare North health centre do not routinely screen HIV positive patients for hypertension. The objective of this study was to assess the prevalence and determinants of hypertension among HIV positive patients at Mathare North health centre, Nairobi. A cross-sectional, mixed method study was conducted in Mathare North Health Centre located in Nairobi – Kenya, Ruaraka Sub County, Mathare North ward. A random sample of 148 participants was drawn from the study population. A questionnaire (modified from the WHO STEPs tool) was used to collect quantitative data from the participants and the registers available at the clinic while focus group discussions and key informant interviews were used for qualitative data. Data was collected on social, economic, demographic, behavioural, physiological and biomedical factors. Measurements of height, weight, blood pressure and blood glucose were taken for all respondents. Descriptive, univariable and multivariable analysis was done using Stata software, version 11 to show which determinants were statistically significant. The qualitative data from the focus group discussions and Key informant interviews was transcribed then analysed using NVivo, 2020. Ethical approval was sought from the KNH-UoN ERC and Nairobi Metropolitan Services (NMS) –Health department before proceeding with the research. Only the patients who gave written approval by signing the consent forms were included in the study. Of the 148 participants included in the analysis, 17.5% were classified as hypertensive. Male respondents represented 51.4%. The participants’ ages ranged between 25 and 73 years with a median age of 40 and an IQR of 15 years. In terms of physiological and behavioural factors, xiv 4.7% and 1.3% of the participants reported current alcohol and harmful alcohol consumption respectively. Majority of the participants (57.4%) reported insufficient physical activity while all had insufficient daily intake of fruits and vegetables. From the multivariable analysis after controlling for other factors, current use of alcohol (aOR 6.78; 95% CI 1.13-40.50) and current regimen – EFV based (aOR 7.48; 95% CI 1.02-55.05) were associated with hypertension in HIV positive patients on ART. Stress and unhealthy diet were reported as the most significant factors associated with hypertension from the qualitative data collected through the focus group discussions and key informant interviews. Therefore, Nairobi Metropolitan services health department, the facility health management team and the implementing partners needs to put in place proper structures for patient health education on predisposing factors (with a focus on modifiable risk factors), blood pressure screening for all patients, proper diagnostic systems and support groups for the hypertensive patients at the clinic to help mitigate stress.