P3817Predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in a rural South African setting

Abstract

Abstract Background South Africa is undergoing an epidemiological transition with a dual burden of chronic communicable and non-communicable diseases. A pilot integrated chronic disease management (ICDM) model was initiated in 2011 by the National Department of Health in selected primary health care (PHC) facilities. The aim of the ICDM model is to leverage an established HIV treatment programme for non-communicable diseases (NCDs) for better health outcomes of patients with chronic diseases. Purpose This study determined predictors of controlled CD4 count and blood pressure (BP) in hypertension and HIV patients receiving antihypertension medication and antiretroviral drugs, respectively in PHC facilities in the Bushbuckridge sub-district of Mpumalanga province, South Africa. Methods This was a panel study to assess the effectiveness of the ICDM model in controlling patients' CD4 count and BP. Patients ≥18 years were recruited through a three-step sampling process into the ICDM model facilities (n=435) and comparison facilities (n=443) in the Bushbuckridge sub-district. Health outcome data (BP and CD4 counts) for each patient were retrieved from health facility records over 30 months (January 2011 to June 2013). Control of BP and CD4 counts were defined as BP <140/90 mmHg and CD4 counts >350 cells/mm3, respectively. Multilevel logistic regression analyses were conducted to determine predictors of controlled CD4 count and controlled hypertension. Data were analysed using Stata 14 statistical software. Results The odds of controlling CD4 count were increased by reception of care at the ICDM model facilities (OR=4.05, 95% CI: 2.77–5.92), but decreased by male gender (OR=0.52, 95% CI: 0.34–0.80). The odds of controlling hypertension were higher with increasing age: 40–49 years (OR=6.02, 95% CI: 2.07–17.57); 50–59 years (OR=23.17, 95% CI: 7.46–72.16); ≥60 years (OR=77.48, 95% CI: 25.03–82.26), but decreased by male gender (OR=0.38, 95% CI: 0.21–0.69). Conclusion Application of the ICDM model appeared effective in controlling patients' CD4 counts, but not their BP; hence, the HIV programme should be more extensively leveraged for hypertension treatment in health facilities in the study setting. Health education programmes to improve HIV treatment outcomes should focus on males. Hypertension educational programmes should target younger males in the study setting. Acknowledgement/Funding Fogarty International Centre of the National Institutes of Health under the Award number D43 TW008330