Evaluating linkage to care for hypertension after community-based screening in rural Uganda.
OBJECTIVE
To determine the frequency and predictors of hypertension linkage to care after implementation of a linkage intervention in rural Uganda.


METHODS
During a multidisease screening campaign for HIV, diabetes and hypertension in rural Uganda, hypertensive adults received education, appointment to a local health facility and travel voucher. We measured frequency and predictors of linkage to care, defined as visiting any health facility for hypertension management within 6 months. Predictors of linkage to care were calculated using collaborative-targeted maximum likelihood estimation (C-TMLE). Participants not linking were interviewed using a standardised instrument to determine barriers to care.


RESULTS
Over 5 days, 2252 adults were screened for hypertension and 214 hypertensive adults received a linkage intervention for further management. Of these, 178 (83%) linked to care within 6 months (median = 22 days). Independent predictors of successful linkage included older age, female gender, higher education, manual employment, tobacco use, alcohol consumption, hypertension family history and referral to local vs. regional health centre. Barriers for patients who did not see care included expensive transport (59%) and feeling well (59%).


CONCLUSIONS
A community health campaign that offered hypertension screening, education, referral appointment and travel voucher achieved excellent linkage to care (83%). Young adults, men and persons with low levels of formal education were among those least likely to seek care.
Division of HIV/AIDS, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Makerere University-University of California San Francisco Research Collaboration, Mbarara, Kampala, Uganda.
Prashant
P
Kotwani
Laura
L
Balzer
Dalsone
D
Kwarisiima
Tamara D
TD
Clark
Jane
J
Kabami
Dathan
D
Byonanebye
Bob
B
Bainomujuni
Douglas
D
Black
Gabriel
G
Chamie
Vivek
V
Jain
Harsha
H
Thirumurthy
Moses R
MR
Kamya
Elvin H
EH
Geng
Maya L
ML
Petersen
Diane V
DV
Havlir
Edwin D
ED
Charlebois
D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D001071:Appointments and Schedules; D003153:Community Health Services / Q000379:methods / Q000458:organization & administration*; D015897:Comorbidity; D004522:Educational Status; D005260:Female; D005380:Financing, Government; D005544:Forecasting; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000628:therapy; D008019:Life Style; D016013:Likelihood Functions; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D011306:Prescription Fees; D011446:Prospective Studies; D012017:Referral and Consultation; D012423:Rural Health; D014186:Transportation / Q000191:economics; D014454:Uganda; D055815:Young Adult
D000959:Antihypertensive Agents
Uganda; community-based screening; evaluation; hypertension; rural