Key result
Following home-based screening, only 26.9% of individuals newly diagnosed with elevated blood pressure linked to care within 2 years, with higher linkage among women (aOR 2.41) and older adults.
Why the study?
Community-based screening has been promoted to improve diagnostic efficiency for non-communicable diseases, but few data exist on its downstream impact on linkage to care.
What is the rate of linkage to care following home-based blood pressure screening in rural South Africa?
Cohort (n=1,706)
What is the rate of linkage to care following home-based blood pressure screening in rural South Africa?
Home-based blood pressure screening in rural South Africa resulted in low rates of linkage to care, particularly among men, younger individuals, and the employed, highlighting the need to address barriers to care.
Low linkage after home-based screening signals need for follow-up strategies in rural South Africa; leaves optimal interventions open for prospective trials.
OBJECTIVES: The expanding burden of non-communicable diseases (NCDs) globally will require novel public health strategies. Community-based screening has been promoted to augment efficiency of diagnostic services, but few data are available on the downstream impact of such programmes. We sought to assess the impact of a home-based blood pressure screening programme on linkage to hypertension care in rural South Africa. SETTING: We conducted home-based blood pressure screening withinin a population cohort in rural KwaZulu-Natal, using the WHO Stepwise Approach to Surveillance (STEPS) protocol. PARTICIPANTS: Individuals meeting criteria for raised blood pressure (≥140 systolic or ≥90 diastolic averaged over two readings) were referred to local health clinics and included in this analysis. We defined linkage to care based on self-report of presentation to clinic for hypertension during the next 2 years of cohort observation. We estimated the population proportion of successful linkage to care with inverse probability sampling weights, and fit multivariable logistic regression models to identify predictors of linkage following a positive hypertension screen. RESULTS: Of 11 694 individuals screened, 14.6% (n=1706) were newly diagnosed with elevated pressure. 26.9% (95% CI 24.5% to 29.4%) of those sought hypertension care in the following 2 years, and 38.1% (95% CI 35.6% to 40.7%) did so within 5 years. Women (adjusted OR (aOR) 2.41, 95% CI 1.68 to 3.45), those of older age (aOR 11.49, 95% CI 5.87 to 22.46, for 45-59 years vs <30) and those unemployed (aOR 1.71, 95% CI 1.10 to 2.65) were more likely to have linked to care. CONCLUSIONS: Linkage to care after home-based identification of elevated blood pressure was rare in rural South Africa, particularly among younger individuals, men and the employed. Improved understanding of barriers and facilitators to NCD care is needed to enhance the effectiveness of blood pressure screening in the region.
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Siedner et al. (2018) conducted a cohort in Hypertension (n=1,706). Home-based blood pressure screening was evaluated on Linkage to care based on self-report of presentation to clinic for hypertension during the next 2 years (95% CI 24.5-29.4). Following home-based screening, only 26.9% of individuals newly diagnosed with elevated blood pressure linked to care within 2 years, with higher linkage among women (aOR 2.41) and older adults.
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