Skip to main content

Table 5 Barriers and facilitators for integrated HTN/HIV care in the HIV clinic as related to the domains of COM-B model

From: Hypertension care cascade at a large urban HIV clinic in Uganda: a mixed methods study using the Capability, Opportunity, Motivation for Behavior change (COM-B) model

COM-B domain

Barriers

Facilitators

Psychological capability

Patient lack of knowledge of HTN risk, complications, HTN-HIV drug interactions, and self-management

Healthcare providers have adequate knowledge of HTN screening

Healthcare providers lack knowledge of treating HTN and HTN-HIV drug interactions

Healthcare providers and patients can leverage ART adherence support which is already being provided to PLHIV to provide adherence support for both HTN and HIV treatment

Lack of monitoring indicators for HTN

Physical capability

There were no barriers in this domain

HTN/HIV peer educators and healthcare providers have adequate skills to screen for HTN among PLHIV

Measuring BP is easy for most of the healthcare providers including HIV peer educators

Physical opportunity

Lack of simple evidence-based treatment protocol for HTN care

Availability of BP machines and staff to measure and record blood pressure

Lack of on-site HTN medications despite demand from patients and providers

Cost of buying anti-hypertensive medicines is high; patients cannot afford

Inadequate maintenance of automated BP machines at the HIV clinic

Lack of data collection tools and databases for HTN care

Social opportunity

HTN prescriptions are mainly done by doctors; limited task shifting to clinical officers and nurses

Patients are interested in being supported by PLHIV peer educators to improve adherence to HTN and HIV treatment

Reflective motivation

Patients prioritize adherence to ART over HTN medications

Patients and healthcare providers have great interest in HTN/HIV integrated care

Automatic motivation

Lack of performance targets and review of HTN care quality

There were no facilitators in this domain