Characteristics and Patterns of Retention in Hypertension Care in Primary Care Settings From the Hypertension Treatment in Nigeria Program
Jiancheng Ye, Ikechukwu A. Orji, Abigail S. Baldridge, Tunde M. Ojo, Grace Shedul, Eugenia N. Ugwuneji, Nonye Egenti, Kasarachi Aluka-Omitiran, Rosemary Okoli, Helen Eze, Ada Nwankwo, Lisa R. Hirschhorn, Aashima Chopra, Boni Maxime Ale, Gabriel Shedul, Priya Tripathi, Namratha R. Kandula, Mark D. Huffman, Dike Ojji, Hypertension Treatment in Nigeria Program Investigators, Regina Asuku, Elizabeth Ngadda, Joel Abu, Alice Osuji, Blessing Akor, Charity Akor, Christine Archibong, Haruna Abubakar, Confidence Joseph-Alo, Emmanuel Odo, Douglas Okoye, Grace Afolabi, Emmanuel Okpetu, Nana Ripiye, Dorothy Ihegazie, Christian Ukeh, Vivian Chukwuma, Nicholas Baamlong, Sani Mohammed, Deborah Joshua, Saleh Ashafa, Hope Omeiza, Mercy U. Ikechukwu-Orji
Abstract
Background: More than 1.2 billion adults worldwide have hypertension. High retention in clinical care is essential for long-term management of hypertension, but 1-year retention rates are less than 50% in many resource-limited settings. Objective: To evaluate short-term retention rates and associated factors among patients with hypertension in primary health care centers in the Federal Capital Territory of Nigeria. Design, Setting, and Participants: In this cohort study, data were collected by trained study staff from adults aged 18 years or older at 60 public, primary health care centers in Nigeria between January 2020 and July 2021 as part of the Hypertension Treatment in Nigeria (HTN) Program. Patients with hypertension were registered. Exposures: Follow-up visit for hypertension care within 37 days of the registration visit. Main Outcomes and Measures: The main outcome was the 3-month rolling average 37-day retention rate in hypertension care, calculated by dividing the number of patients who had a follow-up visit within 37 days of their first (ie, registration) visit in the program by the total number of registered patients with hypertension during multiple consecutive 3-month periods. Interrupted time series analyses evaluated trends in retention rates before and after the intervention phase of the HTN Program. Mixed-effects, multivariable regression models evaluated associations between patient-, site-, and area council-level factors, hypertension treatment and control status, and 37-day retention rate. Results: In total, 10 686 patients (68.3% female; mean [SD] age, 48.8 [12.7] years) were included in the analysis. During the study period, the 3-month rolling average 37-day retention rate was 41% (95% CI, 37%-46%), with wide variability among sites. The retention rate was higher among patients who were older (adjusted odds ratio [aOR], 1.01 per year; 95% CI, 1.01-1.02 per year), were female (aOR, 1.11; 95% CI, 1.01-1.23), had a higher body mass index (aOR, 1.01; 95% CI, 1.00-1.02), were in the Kuje vs the Abaji area council (aOR, 2.25; 95% CI, 1.25-4.04), received hypertension treatment at the registration visit (aOR, 1.27; 95% CI, 1.07-1.50), and were registered during the postintervention period (aOR, 1.16; 95% CI, 1.06-1.26). Conclusions and Relevance: The findings suggest that retention in hypertension care is suboptimal in primary health care centers in Nigeria, although large variability among sites was found. Potentially modifiable and nonmodifiable factors associated with retention were identified and may inform multilevel, contextualized implementation strategies to improve retention.