Hypertension knowledge, self-management barriers, and provider counseling among women living with HIV and hypertension in KwaZulu-Natal, South Africa: a cross-sectional study

Background In South Africa, despite high rates of HIV control, rates of hypertension control are low. We sought to understand factors associated with hypertension control in women receiving integrated care for HIV and hypertension. Methods We performed a cross-sectional study with women (≥ 18 years) receiving treatment for HIV and hypertension at five clinics in KwaZulu-Natal. The sample was enrolled to balance controlled (< 140/90 mmHg) and uncontrolled hypertension based on blood pressure on the day of the visit. An exit survey was performed to collect data on sociodemographic characteristics, knowledge about hypertension, barriers to self-management, and recall of provider counseling about hypertension from that day. Chi-square and t-tests were used to compare findings by hypertension control status. Results 252 women were enrolled between June-August 2024: median age was 53 years, duration of hypertension 7 years, and 54% had uncontrolled hypertension. There were gaps in hypertension knowledge with no significant differences by control: 31% of women did not identify salt as a risk factor for hypertension and 45% incorrectly believed that blood pressure medications could be stopped once blood pressure normalized. Almost all women (98%) had barriers to exercise, most commonly due to lack of safe spaces and time; 63% had barriers to healthy eating. Counseling about hypertension was variable and not statistically different by control. Conclusions In this population of women with HIV and hypertension, there were important gaps in hypertension knowledge, barriers to diet and exercise were common, and provider counseling about hypertension was inconsistent, suggesting modifiable areas for interventions to improve hypertension outcomes.