Feasibility of community-based hypertension screening and referral by village health teams in eastern Uganda: A quasi-experimental study.

BACKGROUND

Uganda has a high prevalence of hypertension (HTN) and low diagnosis rates due to healthcare system deficiencies, like scarce diagnostic resources and a shortage of health workers. Task-shifting roles to community health workers (CHWs) could potentially fill gaps in the control of HTN, but this is still underexplored. This study determined the feasibility of leveraging CHWs, called Village Health Teams (VHTs), for HTN screening and referral in Eastern Uganda.

METHODS

We conducted a quasi-experimental study from June to November 2023 in Bugembe town council, Jinja City, Eastern Uganda. Twelve VHT members were trained and deployed to screen and refer hypertensive patients in their communities. The training covered the basics of hypertension, blood pressure measurement, and referral protocols. VHTs screened adults aged 18 years or older from their homes or workplaces using automatic blood pressure machines. Participants with elevated blood pressure (≥ 140/90 mmHg) on two measurements 15 min apart were referred to a local health center for diagnosis and management. Data was collected on participant demographics, blood pressure readings, and screening-referral cascade and analyzed using STATA 15.0. Change in the number of newly diagnosed patients at the facility before and after the intervention was assessed using a paired t-test. A p-value < 0.05 was considered statistically significant.

RESULTS

The VHTs screened 5,215 individuals, with a mean age of 34 (SD: 12.3) years. The prevalence of elevated blood pressure (BP) was 22.4% (n = 1167). Factors associated with elevated BP were older age, being male, having had previous blood pressure measurements, and alcohol use. Approximately 23.8% (n = 278/1167) of participants with elevated BPs accepted referral, 24.8% (n = 69/278) reached the facility, and most of these (n = 65/69, 94.3%) were confirmed to be hypertensive. The monthly average number of new hypertensive patients at the health centre increased significantly from 4.6 ± 0.9 to 12.7 ± 1.4 four months before and after the intervention (t = 4.37, p = 0.0014).

CONCLUSION

VHTs can reliably screen for HTN with appropriate training. However, strategies are needed to improve the low referral rates post-screening in the community to achieve the desired outcomes of early diagnosis and management of HTN.