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Multilevel predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in rural South Africa: a panel study

OBJECTIVE: In 2011, The National Department of Health introduced the Integrated Chronic Disease Management (ICDM) model as a pilot programme in selected primary healthcare facilities in South Africa. The objective of this study was to determine individual-level and facility-level predictors of contr...

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Autores principales: Ameh, Soter, Gómez-Olivé, Francesc X, Kahn, Kathleen, Tollman, Stephen, Klipstein-Grobusch, Kerstin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640524/
https://www.ncbi.nlm.nih.gov/pubmed/33148729
http://dx.doi.org/10.1136/bmjopen-2020-037580
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author Ameh, Soter
Gómez-Olivé, Francesc X
Kahn, Kathleen
Tollman, Stephen
Klipstein-Grobusch, Kerstin
author_facet Ameh, Soter
Gómez-Olivé, Francesc X
Kahn, Kathleen
Tollman, Stephen
Klipstein-Grobusch, Kerstin
author_sort Ameh, Soter
collection PubMed
description OBJECTIVE: In 2011, The National Department of Health introduced the Integrated Chronic Disease Management (ICDM) model as a pilot programme in selected primary healthcare facilities in South Africa. The objective of this study was to determine individual-level and facility-level predictors of controlled CD4 count and blood pressure (BP) in patients receiving treatment for HIV and hypertension, respectively. DESIGN: A panel study. SETTING AND PARTICIPANTS: This study was conducted in the Bushbuckridge Municipality, South Africa from 2011 to 2013. Facility records of patients aged ≥18 years were retrieved from the integrated chronic disease management (ICDM) pilot (n=435) and comparison facilities (n=443) using a three-step probability sampling process. CD4 count and BP control are defined as CD4 count >350 cells/mm(3) and BP <140/90 mm Hg. A multilevel Least Absolute Shrinkage and Selection Operator binary logistic regression analysis was done at a 5% significance level using STATA V.16. PRIMARY OUTCOME MEASURES: CD4 (cells/mm(3)) count and BP (mm Hg). RESULTS: Compared with the comparison facilities, patients receiving treatment in the pilot facilities had increased odds of controlling their CD4 count (OR=5.84, 95% CI 3.21–8.22) and BP (OR=1.22, 95% CI 1.04–2.14). Patients aged 50–59 (OR=6.12, 95% CI 2.14–7.21) and ≥60 (OR=7.59, 95% CI 4.75–11.82) years had increased odds of controlling their CD4 counts compared with those aged 18–29 years. Likewise, patients aged 40–49 (OR=5.73, 95% CI 1.98–8.43), 50–59 (OR=7.28, 95% CI 4.33–9.27) and ≥60 (OR=9.31, 95% CI 5.12–13.68) years had increased odds of controlling their BP. In contrast, men had decreased odds of controlling their CD4 count (OR=0.12, 95% CI 0.10–0.46) and BP (OR=0.21, 95% CI 0.19–0.47) than women. CONCLUSION: The ICDM model had a small but significant effect on BP control, hence, the need to more effectively leverage the HIV programme for optimal BP control in the setting.
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spelling pubmed-76405242020-11-10 Multilevel predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in rural South Africa: a panel study Ameh, Soter Gómez-Olivé, Francesc X Kahn, Kathleen Tollman, Stephen Klipstein-Grobusch, Kerstin BMJ Open Public Health OBJECTIVE: In 2011, The National Department of Health introduced the Integrated Chronic Disease Management (ICDM) model as a pilot programme in selected primary healthcare facilities in South Africa. The objective of this study was to determine individual-level and facility-level predictors of controlled CD4 count and blood pressure (BP) in patients receiving treatment for HIV and hypertension, respectively. DESIGN: A panel study. SETTING AND PARTICIPANTS: This study was conducted in the Bushbuckridge Municipality, South Africa from 2011 to 2013. Facility records of patients aged ≥18 years were retrieved from the integrated chronic disease management (ICDM) pilot (n=435) and comparison facilities (n=443) using a three-step probability sampling process. CD4 count and BP control are defined as CD4 count >350 cells/mm(3) and BP <140/90 mm Hg. A multilevel Least Absolute Shrinkage and Selection Operator binary logistic regression analysis was done at a 5% significance level using STATA V.16. PRIMARY OUTCOME MEASURES: CD4 (cells/mm(3)) count and BP (mm Hg). RESULTS: Compared with the comparison facilities, patients receiving treatment in the pilot facilities had increased odds of controlling their CD4 count (OR=5.84, 95% CI 3.21–8.22) and BP (OR=1.22, 95% CI 1.04–2.14). Patients aged 50–59 (OR=6.12, 95% CI 2.14–7.21) and ≥60 (OR=7.59, 95% CI 4.75–11.82) years had increased odds of controlling their CD4 counts compared with those aged 18–29 years. Likewise, patients aged 40–49 (OR=5.73, 95% CI 1.98–8.43), 50–59 (OR=7.28, 95% CI 4.33–9.27) and ≥60 (OR=9.31, 95% CI 5.12–13.68) years had increased odds of controlling their BP. In contrast, men had decreased odds of controlling their CD4 count (OR=0.12, 95% CI 0.10–0.46) and BP (OR=0.21, 95% CI 0.19–0.47) than women. CONCLUSION: The ICDM model had a small but significant effect on BP control, hence, the need to more effectively leverage the HIV programme for optimal BP control in the setting. BMJ Publishing Group 2020-11-03 /pmc/articles/PMC7640524/ /pubmed/33148729 http://dx.doi.org/10.1136/bmjopen-2020-037580 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Public Health
Ameh, Soter
Gómez-Olivé, Francesc X
Kahn, Kathleen
Tollman, Stephen
Klipstein-Grobusch, Kerstin
Multilevel predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in rural South Africa: a panel study
title Multilevel predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in rural South Africa: a panel study
title_full Multilevel predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in rural South Africa: a panel study
title_fullStr Multilevel predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in rural South Africa: a panel study
title_full_unstemmed Multilevel predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in rural South Africa: a panel study
title_short Multilevel predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in rural South Africa: a panel study
title_sort multilevel predictors of controlled cd4 count and blood pressure in an integrated chronic disease management model in rural south africa: a panel study
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640524/
https://www.ncbi.nlm.nih.gov/pubmed/33148729
http://dx.doi.org/10.1136/bmjopen-2020-037580
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