Patient-Led Peer Support Groups Improve Anti-Hypertensive Drugs Access For Adults Living With HIV And Hypertension In Rural Uganda – A Cross-Sectional Study

Patient-Led Peer Support Groups Improve Anti-Hypertensive Drugs Access For Adults Living With HIV And Hypertension In Rural Uganda – A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patient-Led Peer Support Groups Improve Anti-Hypertensive Drugs Access For Adults Living With HIV And Hypertension In Rural Uganda – A Cross-Sectional Study Mucunguzi Atukunda, Brian Twinamatsiko, Michael Ayebare, Elizabeth Arinitwe, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6445280/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : People living with HIV (PLHIV) often have poorly controlled hypertension due to medication non-adherence, primarily caused by limited access to antihypertensive drugs. Peer support groups are being explored to improve access. We evaluated the feasibility and acceptability of peer support groups to improve access to anti-hypertensive drugs for PLHIV with hypertension. Methods : From December 2022 to April 2023, we conducted a cross-sectional survey and measurement of blood pressure among PLHIV in 26 health facilities to assess the accessibility of anti-hypertensive drugs in the peer support groups. The collected data was summarized using descriptive statistics Results : Eight out of 26 health facilities formed peer support groups. Among 163 PLHIV interviewed only 64 participated in the peer support groups. Among those who participated in peer support groups 57% reported accessing anti-hypertensive drugs through the group. The peer support groups were affordable for most participants. Around 60% found the contributions manageable, with 79% contributing $1.3 or less. Most participants expressed confidence in the performance of the peer support groups. Conclusion : The results of the study suggest that patient-led peer support groups are a feasible intervention to improve access to hypertensive medications for PLHIV with Hypertension. HIV Hypertension Peer Support groups Anti-Hypertensive drugs multi-morbidity Figures Figure 1 Contributions to the literature This study represents the first exploration of peer support groups for individuals living with HIV and diagnosed with hypertension in low-resource settings. To address medication access challenges, these groups can pool funds to purchase antihypertensive medications in bulk, securing a more affordable and consistent supply. This strategy aims to ensure continuous access to essential medications for all group members, even when healthcare facilities experience shortages. The current study contributes insight into the feasibility of patient-led peer support groups and how they can be utilized to enhance patient self-management strategies, thereby empowering patients to take proactive steps in managing their health. Introduction Hypertension among people living with HIV (PLHIV) shows a growing trend globally ( 1 ). With the introduction of Anti-retroviral therapy (ART), the life expectancy of PLHIV has substantially improved ( 2 ). As a result of ageing, PLHIV are at a higher risk of suffering multi-morbidity including HTN ( 3 ). The prevalence of hypertension among PLHIV ranges from 17–50% in low- and middle-income countries( 4 – 8 ). The management of PLHIV with hypertension includes lifestyle modifications and the use of anti-hypertensive medicines( 9 ). The use of anti-hypertensive drugs is the mainstay treatment of uncontrolled Hypertension. However, Hypertension control among PLHIV is sub-optimal ( 10 , 11 ) and non-adherence to anti-hypertensive medicine remains the leading cause of sub-optimal Hypertension control among Hypertension patients ( 12 ). One of the key drivers of non-adherence is limited access to drugs because of high costs, lack of knowledge among health providers, and clinical inertia. The World Health Organization (WHO) calls for increased access and affordability of all medicines ( 13 ). However, access to drugs to prevent and treat non-communicable diseases (NCDs) is unacceptably low in Uganda ( 14 – 18 ). The inadequacy of stocks of medicines for NCDs affects all hypertension patients including PLHIV( 19 , 20 ). Thus, low- and middle-income countries are encouraged to increase mobilization of domestic resources to cater for the many patients with NCDs with limited access to anti-hypertensives ( 21 ). Even then, national government mobilization is limited and the burden of access to anti-hypertensive medicines is largely left to patients to make out-of-pocket payments. Peer support groups have been instrumental in providing support to patients with chronic illnesses ( 22 ). Peer-to-peer engagements create opportunities for support in areas such as adherence, counselling, patient education and patient advocacy ( 23 ). In the case of Uganda, the Ministry of Health (MoH) supports the formation of patient associations to tackle the issue of drug stockouts. In that regard, MoH issued guidance to healthcare managers allowing the formation of peer support groups. The peer support groups ask members to make voluntary financial contributions to purchase anti-hypertensive drugs in bulk at a low cost. This ensures that all patients in the support group access anti-hypertensive medicines during routine clinic visits to the health facility. HIV-related clinical activities offered at the health facilities included HIV testing counselling and management of ART. Provision of HIV services at these health facilities is made by, medical doctors, clinical officers, nurses, HIV counsellors, laboratory technicians, pharmacy technicians, and record officers, supported by HIV expert clients. HTN care and treatment services are routinely offered at all these health facilities. If a PLHIV has Hypertension, the clinician prescribes both ART and Hypertension medicines and gives the individual a future appointment for clinical evaluation and monitoring. All available drugs and services at the health facility are provided at no cost to the patients. However, during drug stock-out periods, patients are advised to purchase medicines at private pharmacies of their preference. The work detailed in this manuscript was performed alongside that of the Integrated HIV/HTN project a cluster randomized trial ( https://classic.clinicaltrials.gov/ct2/show/NCT04624061 ). As part of the Integrated HIV/HTN project implementation, project staff recommended establishing peer support groups at health facilities, aligning with Ministry of Health guidance. The Integrated HIV/HTN project aimed to measure the effectiveness of integration on HTN screening, blood pressure control and dual HIV and HTN control among PLHIV. We evaluated the feasibility and acceptability of patient-led peer support groups to improve anti-hypertensive drug stockouts for PLHIV with HTN within the Integrated HIV/HTN project. Methods Study design We conducted a cross-sectional survey using a structured questionnaire to a randomly selected PLHIV with HTN attending peer support groups and PLHIV with HTN not attending peer support groups from 1 December 2022 to 28 April 2023. Study setting and population The study was conducted at intervention health facilities under the Integrated HIV/HTN project in South-western Uganda (See Fig. 1 ). There were 26 government-supported health facilities under the intervention providing comprehensive HIV services with the number of PLHIV at the health facility ranging from 200–1,000 persons. The intervention package components included ( 1 ) Training and capacity building on the Integrated HIV/HTN model and NCD care. ( 2 ) The Integrated HIV/HTN care delivery model by promoting HTN screening and care in HIV clinics. ( 3 ) HMIS enhancements through mentorship and coaching on the use of NCD registers and patient cards, and capture of HTN data in the existing Electronic Medical Records (EMR) of Uganda; and ( 4 ) SMS and/or WhatsApp messages for data coordination and communication among providers, District Health Officers, and project staff. The integrated HIV/HTN protocol has been published ( 24 ). Formation of peer support groups: The concept of peer support groups was introduced to the study facilities by the Integrated HIV/HTN project team during a performance review meeting attended by superintendents of all the participating health facilities in April 2021. This followed reports from healthcare providers indicating that many health facilities experienced frequent stockouts of anti-hypertensive medicines due to intermittent government supplies. Consequently, several PLHIV and Hypertension spent months without anti-hypertensive medicines. To improve the availability of drugs for non-communicable diseases, the Uganda Ministry of Health had recommended formation of peer support groups. The peer support groups would work by asking members of the support group to collectively raise funds to buy drugs in bulk at a cheaper price. The peer support groups would select an executive committee among the members to support different tasks. The executive committee comprised at least a chairperson, a secretary, and a treasurer. The treasurer was charged with receiving and keeping the members’ financial contributions. Following that consultative performance review meeting in the Integrated HIV/HTN project, healthcare providers mobilized and encouraged several patients to form patient-led peer support groups attached to their health facilities. The health facilities that formed patient-led peer support groups include Ndeija Health center (HC) III, Ntugamo HC IV, Kibaale HC IV, Mugarama HC III, Rwekubo HC IV, Kakoba HC III and Mwizi HC III. We also included Ruhoko HC IV which was not part of the integrated HIV/HTN project but had an active peer support group. A Level IV health facility is overseen by a Medical Doctor and serves a population of 100,000 to 500,000 within its catchment area. These facilities are equipped to handle a wider range of medical needs, including inpatient care with a 30-bed capacity, surgical procedures in an operating theatre, diagnostic testing in a general laboratory, and ongoing management of HIV with a dedicated chronic care unit. In contrast, Level III Health facilities are led by a qualified clinician, nurse, or midwife. They cater to a population of up to 30,000 within their designated area and focus on primary care services. These facilities typically include outpatient departments, maternity wards, and HIV chronic care units. It's important to clarify that peer support groups were not originally included in the integrated HIV/HTN project interventions. However, the project team encouraged health facilities to establish these groups as a complementary strategy to help patients access and adhere to their hypertension medication. Each peer support group typically comprised 5–15 PLHIV who also had hypertension, alongside 10–30 non-HIV individuals with HTN. These groups functioned under a patient-led model, meaning patients managed and facilitated the group discussions and activities. However, the health providers gave oversight and technical support whenever needed. Healthcare providers offered technical support to the peer support groups by recommending appropriate antihypertensive medications and, in some cases, suggesting reliable sources for purchasing these medications. Participation in the peer support groups was entirely voluntary, with patients free to join or leave at any time. For cost estimates, the exchange rate was around 3846 Ugandan shillings (UGX) to 1 US dollar in 2022. Data collection procedures We collected data on basic demographics, and blood pressure (BP) measurements during the survey. Blood Pressure measurement was conducted using sphygmomanometers (Omron M2 Intellisense™ Automatic Blood Pressure Monitor, Lake Forest, IL. USA) after an initial period of a seated 5-minute rest. When the first BP measurement reading was normal (< 140/<90 mmHg), no additional BP readings were taken. However, when the first reading was 140/90 mmHg or higher, two additional readings were performed at alternate patient arms three minutes apart, the average BP reading among the three readings would be recorded as final. Study Outcomes The primary outcome was the accessibility of anti-hypertensive drugs through the peer support groups, measured as the number of PLHIV with HTN accessing anti-hypertensives through the peer support groups. Secondary outcomes were participant participation rates in the support groups, measured as the number of PLHIV with HTN willing to join patient clubs and acceptability measured as the number of PLHIV with HTN willing to pool funds in the peer support group to buy drugs. Data Analysis Baseline information was collected and summarized using descriptive statistics. Blood Pressure findings were categorized using the 2020 guidelines of the American Society of Hypertension and the International Society of Hypertension: Normal: <140/90 mmHg; Grade-1 HTN: 140–159/90–99 mmHg; Grade-2 HTN: 160–179/100–109 mmHg; Grade-3 HTN:≥180/110 ( 25 ). Results From 3 December 2022 to 20 April 2023, eight out of twenty-six (30.7%) health facilities had established peer support groups for diabetes and hypertension. Health facilities were evenly distributed, with four health facilities at level IV (Ntungamo HC IV, Kibaale HC IV, Ruhoko HC IV and Rwekubo HC IV) and four health facilities at level III (Ndeija HC III, Mugarama HC III, Kakoba HC III and Mwizi HC III). Out of the 163 PLHIV participants interviewed, 39.3% (64 participants) were members of peer support groups. More than two-thirds (107) of the PLHIV participants received care at Level IV health facilities. There were more PLHIV 58/63 (90.5%) enrolled at Level IV health facilities than at Level III facilities with just 6/63 (9.5%). There was no variation in the number of PLHIV not participating in HTN peer support groups by level of health facility (50.5%) at level III vs 49.5% at Level IV. Slightly over half of the participants 55.2% (90/163) were females, with variation by membership status; 38 (60.3%) were in the HTN peer support group and 52 (52.5%) were not in a peer support group. The mean age for participants was 51.7 years and did not differ by HTN peer support group participation status. Over half of the participants, 97/163 (59.5%) had attained a primary level of education and this did not differ by peer support group participation status; with 38 (23.3%) reporting to have never attended school at all. Most of the PLHIV (99.4%) were on pharmacological HTN treatment, with one participant on the non-pharmacological HTN treatment. Duration of treatment among the participants varied with more than half of the participants having been on treatment for over 6 months. Overall, 41.1% (67/163) had controlled blood pressure at the time survey and it varied significantly by peer support group participation; with 53.1% (34/64) participants in the peer support group and 33.3% (33/99) participants not in the peer support groups. Nearly all participants (97.5%) had been on ART treatment for more than a year. (Table 1). Participation of PLHIV in the peer support groups: The duration for participation in the HTN peer support varied by months as follows; 6/63(9.5%) for <1 month, 25/63 (40%) for 1-3 months, 21/63 (33%) for 4-6 months, 5/63 (7.9%) for 6-12 months and 6/63 (9.5%) for over 12 months. Among those who participated in peer support groups 57% (36/63) reported accessing anti-hypertensive drugs through the group. Less than half (44.4%) of participants did not spend on buying HTN medication before joining the peer support group. Whereas one individual (1.5%) spent between UGX10,000 – 30,000 (USD 2.6 – 7.8), 22/63 (34.9%) spent between UGX5,000 – 10,000 (USD 1.3 – 2.6), and 12/63 (19%) spent less than UGX. 5,000 (USD 1.3) averagely per month on buying HTN medications before joining the peer support group. The amount of money contributed by each PLHIV to the peer support group varied greatly among participants, with 21/63 (33%) contributing UGX. 3,000 (USD 0.8), 29/63 (46%) UGX. 5,000 (USD 1.3), 2/63 (3.2) UGX. 7,000 (USD 1.8), 8/63 (13%) UGX. 10,000 (USD 2.6) and three individuals (1.6%) each contributing UGX. 20,000 (USD 5.2) and above. More than half 38/63 (60.3%) reported the financial contributions made to the peer support group were affordable. Member contributions to the peer support groups were made either once in three months (52%), or monthly (48%). Fifty-five (85.7%) participants provided answers using the Visual Analogue Scale (0-10) regarding satisfaction with their HTN peer support group. The median score was 6, with an interquartile range of 5 - 8. Among those who responded to the satisfaction question, 52/55 (94.5%) reported satisfaction levels of 5 or more. Activities carried out at the HTN peer support group (n=54), included health education, peer counselling, performing blood pressure measurement and group financial savings. (Table 2) Discussion Peer support groups are one of the approaches to involve patients in the self-management of their chronic health conditions ( 26 ). This study explored peer support groups for PLHIV with hypertension, where participants provided mutual support in managing their conditions. We evaluated the feasibility and acceptability of patient-led peer support groups in improving access to anti-hypertensive drugs for PLHIV with Hypertension. We found peer support group formation was feasible and PLHIV with Hypertension were able to access antihypertensive drugs through the support groups. Eight out of twenty-six health facilities formed peer support groups with equal distribution across health facility levels III and IV. Their formation followed a performance review meeting, where it was noted that a significant number of PLHIV with HTN had poorly controlled blood pressure. One of the underlying reasons for not achieving blood pressure control was limited access to hypertension drugs. Overall, there was low participation (39.3%) of PLHIV in the peer support groups. One of the reasons for low participation in peer support groups was a lack of adequate information about the peer support groups. Others reported challenges in joining because joining the support group required one to make regular financial contributions. PLHIV with HTN diagnoses who participated in peer support groups accessed anti-hypertensive drugs as compared to those who did not participate. Access to anti-hypertensive medicines is a key component to help patients adhere to treatment. This leads to better management and control of high blood pressure to optimal levels( 27 ). In addition, the PLHIV with HTN who participated in the peer support had better blood pressure control compared to the counterparts who were not involved in the peer support groups. Lowering blood pressure has immense benefits such as preventing strokes, heart failure and coronary heart disease( 28 ). Furthermore, most respondents in the peer support group noted that the financial contributions to the group were affordable. Most members who participated in the peer support groups contributed $ 1.3 (UGX 5,000) and below. The amount contributed is comparable to the $ 1.5 ( 29 ) reported in a similar setting in Kenya. The average expenditure before joining the peer support group was higher, with 36.4% of participants spending an average of $ 1.3 to $ 7.8 (UGX 5,000 to UGX30,000). This demonstrates participation in peer support groups could potentially lead to cost savings compared to not participating, although further research is needed to confirm this. By working together, participants in the peer support groups could explore cost-saving strategies for obtaining antihypertensive medications. These strategies might include negotiating bulk discounts with local pharmacies or identifying relevant government programs. This is supported by a report from the national survey on medicines in Uganda( 30 ) which reported that patient prices for the lowest-priced generics were found to be 2.6 times the international reference price at private retail pharmacies. The collaborative approach within the peer support groups resembles a micro-insurance model where all the participants are assured of hypertension medicines as long as they make a financial contribution. And that contribution was not dependent on the type of medicines a patient is on or the severity of the disease. In the care of hypertension, some patients can be initially on a lifestyle modification plan, or pharmacological depending on the level of blood pressure reading. Those on the pharmacological plan may be on 1–3 types of medication( 9 ). So irrespective of the number of hypertension drugs one is taking they all still contribute the same amount. The patients not on treatment also benefit by receiving health education on lifestyle changes offered in the peer support groups. Most participants reported high levels of satisfaction with the performance of the peer support groups. This demonstrated that peer support groups for PLHIV with hypertension can benefit participants at the individual level. Activities carried out at the peer support group were health education, peer-to-peer counselling, and performing blood pressure measurements. These activities form part of and enhance the self-management approaches( 31 ). Education on hypertension is a key strategy for patients and has been demonstrated to improve patients’ understanding of their disease state and treatment( 32 ). Conclusion We found that patient-led peer support groups were a feasible intervention to improve access to essential medicines for PLHIV with HTN in rural settings in Uganda. Our results demonstrate that peer support groups can be leveraged to support patient groups struggling with limited access to a supply of medicines. Further studies are recommended to evaluate the effectiveness of peer support groups on HTN control among PLHIV. Declarations Ethics approval and consent to participate This study was reviewed and approved by Makerere University School of Medicine Research Ethics Committee Reference number 2022 − 356: and the Uganda National Council for Science and Technology Reference number SS1438ES. All participants provided written informed consent to participate in interviews. Strict confidentiality was upheld throughout the study. This includes the use of unique identifiers, password-protected computers, and the storage of documents with patient data under a lock and key cabinet. Unique numbers were used to identify eligible participants, and these were only linked to individual names when inviting participants for interviews. Patients who were newly diagnosed with HTN and/or with a grade-3 HTN were referred to the clinician at the facility for further evaluation and appropriate management. Consent for publication: All participants who were interviewed signed a consent form before the start of the interview indicating that their anonymized data could be used for publication in an academic journal. Competing interests: The authors declare that they have no competing interests. Funding: This research was supported by the Makerere University Implementation Science Program funded by the Fogarty International Center at the National Institutes of Health Grant Number: D43TW010037 and the European and Developing Countries Clinical Trials Partnership (EDCTP) grant number: CSA2018HS-2518. This manuscript was supported by the UK Medical Research Council (MRC) Grant Number: MR/V03510X/1 Authors' information and Author affiliations: 1 Mucunguzi Atukunda, 1 Brian Twinamatsiko; 1 Michael Ayebare; 2 Elizabeth Arinitwe; 3 Aida N Kawuma, 4 Ronald Kiguba 4 Joan Nangendo; 5 Gerald Mutungi; 1,4 Fred C. Semitala; 1,4 Moses R. Kamya; and 1 Jane Kabami. 1 Infectious Diseases Research Collaboration (IDRC) Uganda, 2 Uganda Heart Institute (UHI) Uganda, 3 Infectious Diseases Institute, Makerere University 4 Makerere University, Kampala, Uganda, and 5 Ministry of Health (MoH) Uganda. Author Contribution The authors confirm their contribution to the paper as follows: MuA, GM, FCS, MRK, JN, and JK designed the study; BT, MuA, EA; supervised the study collection in the field; MuA and MiA analysed the data. MuA prepared the initial draft of this manuscript. ANK, and RK supported the writing of the first draft of this manuscript. All authors have read and approved the final manuscript. Acknowledgements: Not applicable Data Availability The authors confirm that the data supporting the findings of this study are available with the article. Raw data that supports the findings of this study are available from the corresponding author upon request. References Xu Y, Chen X, Wang K. Global prevalence of hypertension among people living with HIV: a systematic review and meta-analysis. Journal of the American Society of Hypertension. 2017;11(8):530-40. Marcus JL, Leyden WA, Alexeeff SE, Anderson AN, Hechter RC, Hu H, et al. 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Characteristics Peer Support Group Not in Peer Support Group Total N=63 N=99 N=163 Health Facility Level III Level IV 6 (9.5%) 58 (90.5%) 50 (50.5%) 49 (49.5%) 56 (34.4%) 107 (65.6%) Female, Sex 38 (60.3%) 52 (52.5%) 90 (55.2%) Age, Mean [SD] 52.6 (10.1) 51.1 (12.4) 51.7 (11.6) Education No school Primary Secondary Tertiary/Vocational University Post-graduate 11 42 6 5 0 0 27 55 8 5 3 1 38(23.3%) 97 (59.5%) 14 (8.6%) 10 (6.1%) 3 (1.8%) 1 (0.6%) ART Treatment duration Less than a month 1-3 months 4-6 months 6-12 months 5: More than a year ago 0 0 1 63 1 1 1 96 159 (97.5% Hypertension Treatment Pharmacological Non-pharmacological 64 0 98 1 162 (99.4%) 1 (0.6%) Hypertension treatment duration Less than a month 1-3 months 4-6 months 6-12 months 5: More than a year ago 1 9 10 9 35 2 16 15 24 42 3 (1.8%) 25 (15.3%) 25 (15.3%) 33 (20.2%) 77 (47.2%) Blood pressure control 34 (53.1%) 33 (33.3%) 67 (41.1%) Table 2: Number and proportion of Persons Living with HIV who attended peer support groups and participated in the Cross-sectional survey conducted in Southwestern Uganda from December 2022 to April 2023. Duration of participation in the peer support group N=63 % 12 months 6 9.5 The average amount spent monthly buying HTN medications before joining peer support group N=63 % < $1.3 (<UGX5,000) 12 19.0 $ 1.3 – 2.6 (UGX 5,000-10,000) 22 34.9 $2.6 –7.8 (UGX10,000-30,000) 1 1.5 Not spent 28 44.4 The actual amount contributed to the peer support group (Uganda shillings) N=63 % $0.8 (UGX 3,000) 21 33 $1.3 (UGX 5,000) 29 46 $1.8 (UGX 7,000) 2 3.2 $2.6 (UGX10,000) 8 13 $5.2 (UGX 20,000) 1 1.6 $6.5 (UGX 25,000) 1 1.6 $7.8 (30,000) 1 1.6 Accessibility to HTN drugs through the peer support group N=63 % Yes 36 57 No 27 43 Affordability of the member contributions N=63 % Yes 38 60.3 No 25 39.7 Frequency of contributions n=48 % once a month 23 48 once in 3 months 25 52 Patient satisfaction with the performance of the Peer support group VAS Scale VAS Scale scores % 1 0 0 2 1 1.8 3 1 1.8 4 1 1.8 5 20 36 6 6 11 7 7 13 8 7 13 9 8 15 10 4 7.3 Activities carried out in the Peer support group N=61 % Health education 34 56 Health education & performing BP 4 6.6 Health education, performing BP & peer counselling 3 4.9 Health education & peer counselling 18 30 Health education & group financial savings 2 3.3 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6445280","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471293245,"identity":"605f8fd4-0624-42bb-bdca-98e27cea448e","order_by":0,"name":"Mucunguzi Atukunda","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwUlEQVRIiWNgGAWjYDADfhCRUECKFskGkBYDUrQYHACTRKjUnZH8TLrg12F54/OrEz88MGCQ5xc7gF+L2Y00M+mZfYcNt914u1kC6DDDmbMTCGnJYZPm7TnMuO3G2Q0gLQkGt4nUYr95xtnNP4jXwvPjcOIG/t5tRNpy5pmxNW9DevKMG7zbLBIMJIjwy/Hkh7d5/ljb9vef3XzzR4WNPL80AS1gwNgGJCTAKiWIUA4Gf4CY/wCxqkfBKBgFo2CkAQB22UX85ovkvwAAAABJRU5ErkJggg==","orcid":"","institution":"Infectious Diseases Research Collaboration","correspondingAuthor":true,"prefix":"","firstName":"Mucunguzi","middleName":"","lastName":"Atukunda","suffix":""},{"id":471293247,"identity":"ed35251c-3154-437d-a7f8-33c2e4f6e37f","order_by":1,"name":"Brian Twinamatsiko","email":"","orcid":"","institution":"Infectious Diseases Research Collaboration","correspondingAuthor":false,"prefix":"","firstName":"Brian","middleName":"","lastName":"Twinamatsiko","suffix":""},{"id":471293248,"identity":"58f7471f-2711-4da3-83dd-56c02677699a","order_by":2,"name":"Michael Ayebare","email":"","orcid":"","institution":"Infectious Diseases Research Collaboration","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Ayebare","suffix":""},{"id":471293251,"identity":"329877d2-401f-4303-b017-ac163edf2dd9","order_by":3,"name":"Elizabeth Arinitwe","email":"","orcid":"","institution":"Uganda Heart Institute","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Arinitwe","suffix":""},{"id":471293254,"identity":"3e55767f-12cc-4693-af9a-2d9c9bf9d364","order_by":4,"name":"Aida N Kawuma","email":"","orcid":"","institution":"Infectious Diseases Institute","correspondingAuthor":false,"prefix":"","firstName":"Aida","middleName":"N","lastName":"Kawuma","suffix":""},{"id":471293256,"identity":"2f05dee1-b816-4d66-85f1-3ed254f4406e","order_by":5,"name":"Ronald Kiguba","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Ronald","middleName":"","lastName":"Kiguba","suffix":""},{"id":471293258,"identity":"cb700109-7a31-4228-afd4-72ed39d01e05","order_by":6,"name":"Joan Nangendo","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Joan","middleName":"","lastName":"Nangendo","suffix":""},{"id":471293260,"identity":"612c76c9-f10d-4098-8a0b-8e7fa74c2878","order_by":7,"name":"Gerald Mutungi","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Gerald","middleName":"","lastName":"Mutungi","suffix":""},{"id":471293262,"identity":"97fe06f4-32b7-4083-b041-1309788fb714","order_by":8,"name":"Fred C. Semitala","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Fred","middleName":"C.","lastName":"Semitala","suffix":""},{"id":471293263,"identity":"8b091691-aa53-4e60-aaeb-40eb903544fb","order_by":9,"name":"Moses R. Kamya","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Moses","middleName":"R.","lastName":"Kamya","suffix":""},{"id":471293265,"identity":"50754016-35c9-452c-82f4-43a11ee19e63","order_by":10,"name":"Jane Kabami","email":"","orcid":"","institution":"Infectious Diseases Research Collaboration","correspondingAuthor":false,"prefix":"","firstName":"Jane","middleName":"","lastName":"Kabami","suffix":""}],"badges":[],"createdAt":"2025-04-14 10:53:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6445280/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6445280/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84842961,"identity":"c658769d-8308-4098-93e4-3df65e806fe8","added_by":"auto","created_at":"2025-06-18 02:18:57","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":828855,"visible":true,"origin":"","legend":"\u003cp\u003eMap of Uganda showing the locations of study sites within selected districts in the southwestern region that participated in the cross-sectional survey December 2022 to April 2023. (Grey boundaries represent Districts)\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6445280/v1/4dc062e1d67b09db5fc4b02c.jpeg"},{"id":99311147,"identity":"a29c8200-00eb-485e-9350-06e8f37bbc14","added_by":"auto","created_at":"2025-12-31 16:13:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1576185,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6445280/v1/e60dff38-3001-41d8-8708-3617f78ca52b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patient-Led Peer Support Groups Improve Anti-Hypertensive Drugs Access For Adults Living With HIV And Hypertension In Rural Uganda – A Cross-Sectional Study","fulltext":[{"header":"Contributions to the literature","content":"\u003cul\u003e\n \u003cli\u003eThis study represents the first exploration of peer support groups for individuals living with HIV and diagnosed with hypertension in low-resource settings.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTo address medication access challenges, these groups can pool funds to purchase antihypertensive medications in bulk, securing a more affordable and consistent supply. This strategy aims to ensure continuous access to essential medications for all group members, even when healthcare facilities experience shortages.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThe current study contributes insight into the feasibility of patient-led peer support groups and how they can be utilized to enhance patient self-management strategies, thereby empowering patients to take proactive steps in managing their health.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eHypertension among people living with HIV (PLHIV) shows a growing trend globally (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). With the introduction of Anti-retroviral therapy (ART), the life expectancy of PLHIV has substantially improved (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). As a result of ageing, PLHIV are at a higher risk of suffering multi-morbidity including HTN (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The prevalence of hypertension among PLHIV ranges from 17\u0026ndash;50% in low- and middle-income countries(\u003cspan additionalcitationids=\"CR5 CR6 CR7\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The management of PLHIV with hypertension includes lifestyle modifications and the use of anti-hypertensive medicines(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The use of anti-hypertensive drugs is the mainstay treatment of uncontrolled Hypertension. However, Hypertension control among PLHIV is sub-optimal (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and non-adherence to anti-hypertensive medicine remains the leading cause of sub-optimal Hypertension control among Hypertension patients (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). One of the key drivers of non-adherence is limited access to drugs because of high costs, lack of knowledge among health providers, and clinical inertia. The World Health Organization (WHO) calls for increased access and affordability of all medicines (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, access to drugs to prevent and treat non-communicable diseases (NCDs) is unacceptably low in Uganda (\u003cspan additionalcitationids=\"CR15 CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The inadequacy of stocks of medicines for NCDs affects all hypertension patients including PLHIV(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Thus, low- and middle-income countries are encouraged to increase mobilization of domestic resources to cater for the many patients with NCDs with limited access to anti-hypertensives (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Even then, national government mobilization is limited and the burden of access to anti-hypertensive medicines is largely left to patients to make out-of-pocket payments.\u003c/p\u003e \u003cp\u003ePeer support groups have been instrumental in providing support to patients with chronic illnesses (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Peer-to-peer engagements create opportunities for support in areas such as adherence, counselling, patient education and patient advocacy (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In the case of Uganda, the Ministry of Health (MoH) supports the formation of patient associations to tackle the issue of drug stockouts. In that regard, MoH issued guidance to healthcare managers allowing the formation of peer support groups. The peer support groups ask members to make voluntary financial contributions to purchase anti-hypertensive drugs in bulk at a low cost. This ensures that all patients in the support group access anti-hypertensive medicines during routine clinic visits to the health facility.\u003c/p\u003e \u003cp\u003eHIV-related clinical activities offered at the health facilities included HIV testing counselling and management of ART. Provision of HIV services at these health facilities is made by, medical doctors, clinical officers, nurses, HIV counsellors, laboratory technicians, pharmacy technicians, and record officers, supported by HIV expert clients. HTN care and treatment services are routinely offered at all these health facilities. If a PLHIV has Hypertension, the clinician prescribes both ART and Hypertension medicines and gives the individual a future appointment for clinical evaluation and monitoring. All available drugs and services at the health facility are provided at no cost to the patients. However, during drug stock-out periods, patients are advised to purchase medicines at private pharmacies of their preference. The work detailed in this manuscript was performed alongside that of the Integrated HIV/HTN project a cluster randomized trial (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://classic.clinicaltrials.gov/ct2/show/NCT04624061\u003c/span\u003e\u003cspan address=\"https://classic.clinicaltrials.gov/ct2/show/NCT04624061\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). As part of the Integrated HIV/HTN project implementation, project staff recommended establishing peer support groups at health facilities, aligning with Ministry of Health guidance. The Integrated HIV/HTN project aimed to measure the effectiveness of integration on HTN screening, blood pressure control and dual HIV and HTN control among PLHIV. We evaluated the feasibility and acceptability of patient-led peer support groups to improve anti-hypertensive drug stockouts for PLHIV with HTN within the Integrated HIV/HTN project.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional survey using a structured questionnaire to a randomly selected PLHIV with HTN attending peer support groups and PLHIV with HTN not attending peer support groups from 1 December 2022 to 28 April 2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy setting and population\u003c/h3\u003e\n\u003cp\u003eThe study was conducted at intervention health facilities under the Integrated HIV/HTN project in South-western Uganda (See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). There were 26 government-supported health facilities under the intervention providing comprehensive HIV services with the number of PLHIV at the health facility ranging from 200\u0026ndash;1,000 persons. The intervention package components included (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Training and capacity building on the Integrated HIV/HTN model and NCD care. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) The Integrated HIV/HTN care delivery model by promoting HTN screening and care in HIV clinics. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) HMIS enhancements through mentorship and coaching on the use of NCD registers and patient cards, and capture of HTN data in the existing Electronic Medical Records (EMR) of Uganda; and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) SMS and/or WhatsApp messages for data coordination and communication among providers, District Health Officers, and project staff. The integrated HIV/HTN protocol has been published (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eFormation of peer support groups:\u003c/h3\u003e\n\u003cp\u003eThe concept of peer support groups was introduced to the study facilities by the Integrated HIV/HTN project team during a performance review meeting attended by superintendents of all the participating health facilities in April 2021. This followed reports from healthcare providers indicating that many health facilities experienced frequent stockouts of anti-hypertensive medicines due to intermittent government supplies. Consequently, several PLHIV and Hypertension spent months without anti-hypertensive medicines. To improve the availability of drugs for non-communicable diseases, the Uganda Ministry of Health had recommended formation of peer support groups. The peer support groups would work by asking members of the support group to collectively raise funds to buy drugs in bulk at a cheaper price. The peer support groups would select an executive committee among the members to support different tasks. The executive committee comprised at least a chairperson, a secretary, and a treasurer. The treasurer was charged with receiving and keeping the members\u0026rsquo; financial contributions. Following that consultative performance review meeting in the Integrated HIV/HTN project, healthcare providers mobilized and encouraged several patients to form patient-led peer support groups attached to their health facilities. The health facilities that formed patient-led peer support groups include Ndeija Health center (HC) III, Ntugamo HC IV, Kibaale HC IV, Mugarama HC III, Rwekubo HC IV, Kakoba HC III and Mwizi HC III. We also included Ruhoko HC IV which was not part of the integrated HIV/HTN project but had an active peer support group. A Level IV health facility is overseen by a Medical Doctor and serves a population of 100,000 to 500,000 within its catchment area. These facilities are equipped to handle a wider range of medical needs, including inpatient care with a 30-bed capacity, surgical procedures in an operating theatre, diagnostic testing in a general laboratory, and ongoing management of HIV with a dedicated chronic care unit. In contrast, Level III Health facilities are led by a qualified clinician, nurse, or midwife. They cater to a population of up to 30,000 within their designated area and focus on primary care services. These facilities typically include outpatient departments, maternity wards, and HIV chronic care units. It's important to clarify that peer support groups were not originally included in the integrated HIV/HTN project interventions. However, the project team encouraged health facilities to establish these groups as a complementary strategy to help patients access and adhere to their hypertension medication. Each peer support group typically comprised 5\u0026ndash;15 PLHIV who also had hypertension, alongside 10\u0026ndash;30 non-HIV individuals with HTN. These groups functioned under a patient-led model, meaning patients managed and facilitated the group discussions and activities. However, the health providers gave oversight and technical support whenever needed. Healthcare providers offered technical support to the peer support groups by recommending appropriate antihypertensive medications and, in some cases, suggesting reliable sources for purchasing these medications. Participation in the peer support groups was entirely voluntary, with patients free to join or leave at any time. For cost estimates, the exchange rate was around 3846 Ugandan shillings (UGX) to 1 US dollar in 2022.\u003c/p\u003e\n\u003ch3\u003eData collection procedures\u003c/h3\u003e\n\u003cp\u003eWe collected data on basic demographics, and blood pressure (BP) measurements during the survey. Blood Pressure measurement was conducted using sphygmomanometers (Omron M2 Intellisense\u0026trade; Automatic Blood Pressure Monitor, Lake Forest, IL. USA) after an initial period of a seated 5-minute rest. When the first BP measurement reading was normal (\u0026lt;\u0026thinsp;140/\u0026lt;90 mmHg), no additional BP readings were taken. However, when the first reading was 140/90 mmHg or higher, two additional readings were performed at alternate patient arms three minutes apart, the average BP reading among the three readings would be recorded as final.\u003c/p\u003e\n\u003ch3\u003eStudy Outcomes\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was the accessibility of anti-hypertensive drugs through the peer support groups, measured as the number of PLHIV with HTN accessing anti-hypertensives through the peer support groups. Secondary outcomes were participant participation rates in the support groups, measured as the number of PLHIV with HTN willing to join patient clubs and acceptability measured as the number of PLHIV with HTN willing to pool funds in the peer support group to buy drugs.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eBaseline information was collected and summarized using descriptive statistics. Blood Pressure findings were categorized using the 2020 guidelines of the American Society of Hypertension and the International Society of Hypertension: Normal: \u0026lt;140/90 mmHg; Grade-1 HTN: 140\u0026ndash;159/90\u0026ndash;99 mmHg; Grade-2 HTN: 160\u0026ndash;179/100\u0026ndash;109 mmHg; Grade-3 HTN:\u0026ge;180/110 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFrom 3 December 2022 to 20 April 2023, eight out of twenty-six (30.7%) health facilities had established peer support groups for diabetes and hypertension. Health facilities were evenly distributed, with four health facilities at level IV (Ntungamo HC IV, Kibaale HC IV, Ruhoko HC IV and Rwekubo HC IV) and four health facilities at level III (Ndeija HC III, Mugarama HC III, Kakoba HC III and Mwizi HC III).\u003c/p\u003e\n\u003cp\u003eOut of the 163 PLHIV participants interviewed, 39.3% (64 participants) were members of peer support groups. More than two-thirds (107) of the PLHIV participants received care at Level IV health facilities. There were more PLHIV 58/63 (90.5%) enrolled at Level IV health facilities than at Level III facilities with just 6/63 (9.5%). There was no variation in the number of PLHIV not participating in HTN peer support groups by level of health facility (50.5%) at level III vs 49.5% at Level IV. Slightly over half of the participants 55.2% (90/163) were females, with variation by membership status; 38 (60.3%) were in the HTN peer support group and 52 (52.5%) were not in a peer support group. The mean age for participants was 51.7 years and did not differ by HTN peer support group participation status. Over half of the participants, 97/163 (59.5%) had attained a primary level of education and this did not differ by peer support group participation status; with 38 (23.3%) reporting to have never attended school at all. Most of the PLHIV (99.4%) were on pharmacological HTN treatment, with one participant on the non-pharmacological HTN treatment. Duration of treatment among the participants varied with more than half of the participants having been on treatment for over 6 months.\u003c/p\u003e\n\u003cp\u003eOverall, 41.1% (67/163) had controlled blood pressure at the time survey and it varied significantly by peer support group participation; with 53.1% (34/64) participants in the peer support group and 33.3% (33/99) participants not in the peer support groups. Nearly all participants (97.5%) had been on ART treatment for more than a year. (Table 1).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipation of PLHIV in the peer support groups:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe duration for participation in the HTN peer support varied by months as follows; 6/63(9.5%) for \u0026lt;1 month, 25/63 (40%) for 1-3 months, 21/63 (33%) for 4-6 months, 5/63 (7.9%) for 6-12 months and 6/63 (9.5%) for over 12 months. Among those who participated in peer support groups 57% (36/63) reported accessing anti-hypertensive drugs through the group.\u003c/p\u003e\n\u003cp\u003eLess than half (44.4%) of participants did not spend on buying HTN medication before joining the peer support group. \u0026nbsp;Whereas one individual (1.5%) spent between UGX10,000 \u0026ndash; 30,000 (USD 2.6 \u0026ndash; 7.8), 22/63 (34.9%) spent between UGX5,000 \u0026ndash; 10,000 (USD 1.3 \u0026ndash; 2.6), and 12/63 (19%) spent less than UGX. 5,000 (USD 1.3) averagely per month on buying HTN medications before joining the peer support group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe amount of money contributed by each PLHIV to the peer support group varied greatly among participants, with 21/63 (33%) contributing UGX. 3,000 (USD 0.8), 29/63 (46%) UGX. 5,000 (USD 1.3), 2/63 (3.2) UGX. 7,000 (USD 1.8), 8/63 (13%) UGX. 10,000 (USD 2.6) and three individuals (1.6%) each contributing UGX. 20,000 (USD 5.2) and above. More than half 38/63 (60.3%) reported the financial contributions made to the peer support group were affordable. Member contributions to the peer support groups were made either once in three months (52%), or monthly (48%). Fifty-five (85.7%) participants provided answers using the Visual Analogue Scale (0-10) regarding satisfaction with their HTN peer support group. The median score was 6, with an interquartile range of 5 - 8. Among those who responded to the satisfaction question, 52/55 (94.5%) reported satisfaction levels of 5 or more. Activities carried out at the HTN peer support group (n=54), included health education, peer counselling, performing blood pressure measurement and group financial savings. (Table 2)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePeer support groups are one of the approaches to involve patients in the self-management of their chronic health conditions (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This study explored peer support groups for PLHIV with hypertension, where participants provided mutual support in managing their conditions. We evaluated the feasibility and acceptability of patient-led peer support groups in improving access to anti-hypertensive drugs for PLHIV with Hypertension. We found peer support group formation was feasible and PLHIV with Hypertension were able to access antihypertensive drugs through the support groups.\u003c/p\u003e \u003cp\u003eEight out of twenty-six health facilities formed peer support groups with equal distribution across health facility levels III and IV. Their formation followed a performance review meeting, where it was noted that a significant number of PLHIV with HTN had poorly controlled blood pressure. One of the underlying reasons for not achieving blood pressure control was limited access to hypertension drugs.\u003c/p\u003e \u003cp\u003eOverall, there was low participation (39.3%) of PLHIV in the peer support groups. One of the reasons for low participation in peer support groups was a lack of adequate information about the peer support groups. Others reported challenges in joining because joining the support group required one to make regular financial contributions.\u003c/p\u003e \u003cp\u003ePLHIV with HTN diagnoses who participated in peer support groups accessed anti-hypertensive drugs as compared to those who did not participate. Access to anti-hypertensive medicines is a key component to help patients adhere to treatment. This leads to better management and control of high blood pressure to optimal levels(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In addition, the PLHIV with HTN who participated in the peer support had better blood pressure control compared to the counterparts who were not involved in the peer support groups. Lowering blood pressure has immense benefits such as preventing strokes, heart failure and coronary heart disease(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Furthermore, most respondents in the peer support group noted that the financial contributions to the group were affordable. Most members who participated in the peer support groups contributed \u003cspan\u003e$\u003c/span\u003e1.3 (UGX 5,000) and below. The amount contributed is comparable to the \u003cspan\u003e$\u003c/span\u003e1.5 ( \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e ) reported in a similar setting in Kenya. The average expenditure before joining the peer support group was higher, with 36.4% of participants spending an average of \u003cspan\u003e$\u003c/span\u003e1.3 to \u003cspan\u003e$\u003c/span\u003e7.8 (UGX 5,000 to UGX30,000). This demonstrates participation in peer support groups could potentially lead to cost savings compared to not participating, although further research is needed to confirm this. \u003c/p\u003e \u003cp\u003eBy working together, participants in the peer support groups could explore cost-saving strategies for obtaining antihypertensive medications. These strategies might include negotiating bulk discounts with local pharmacies or identifying relevant government programs. This is supported by a report from the national survey on medicines in Uganda(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) which reported that patient prices for the lowest-priced generics were found to be 2.6 times the international reference price at private retail pharmacies. The collaborative approach within the peer support groups resembles a micro-insurance model where all the participants are assured of hypertension medicines as long as they make a financial contribution. And that contribution was not dependent on the type of medicines a patient is on or the severity of the disease. In the care of hypertension, some patients can be initially on a lifestyle modification plan, or pharmacological depending on the level of blood pressure reading. Those on the pharmacological plan may be on 1\u0026ndash;3 types of medication(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). So irrespective of the number of hypertension drugs one is taking they all still contribute the same amount. The patients not on treatment also benefit by receiving health education on lifestyle changes offered in the peer support groups.\u003c/p\u003e \u003cp\u003e Most participants reported high levels of satisfaction with the performance of the peer support groups. This demonstrated that peer support groups for PLHIV with hypertension can benefit participants at the individual level. Activities carried out at the peer support group were health education, peer-to-peer counselling, and performing blood pressure measurements. These activities form part of and enhance the self-management approaches(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Education on hypertension is a key strategy for patients and has been demonstrated to improve patients\u0026rsquo; understanding of their disease state and treatment(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe found that patient-led peer support groups were a feasible intervention to improve access to essential medicines for PLHIV with HTN in rural settings in Uganda. Our results demonstrate that peer support groups can be leveraged to support patient groups struggling with limited access to a supply of medicines. Further studies are recommended to evaluate the effectiveness of peer support groups on HTN control among PLHIV.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e This study was reviewed and approved by Makerere University School of Medicine Research Ethics Committee Reference number 2022\u0026thinsp;\u0026minus;\u0026thinsp;356: and the Uganda National Council for Science and Technology Reference number SS1438ES. All participants provided written informed consent to participate in interviews. Strict confidentiality was upheld throughout the study. This includes the use of unique identifiers, password-protected computers, and the storage of documents with patient data under a lock and key cabinet. Unique numbers were used to identify eligible participants, and these were only linked to individual names when inviting participants for interviews. Patients who were newly diagnosed with HTN and/or with a grade-3 HTN were referred to the clinician at the facility for further evaluation and appropriate management.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eAll participants who were interviewed signed a consent form before the start of the interview indicating that their anonymized data could be used for publication in an academic journal.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests:\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis research was supported by the Makerere University Implementation Science Program funded by the Fogarty International Center at the National Institutes of Health Grant Number: D43TW010037 and the European and Developing Countries Clinical Trials Partnership (EDCTP) grant number: CSA2018HS-2518. This manuscript was supported by the UK Medical Research Council (MRC) Grant Number: MR/V03510X/1\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eAuthors' information and Author affiliations:\u003c/h2\u003e \u003cp\u003e \u003csup\u003e1\u003c/sup\u003eMucunguzi Atukunda, \u003csup\u003e1\u003c/sup\u003eBrian Twinamatsiko; \u003csup\u003e1\u003c/sup\u003eMichael Ayebare; \u003csup\u003e2\u003c/sup\u003eElizabeth Arinitwe; \u003csup\u003e3\u003c/sup\u003eAida N Kawuma, \u003csup\u003e4\u003c/sup\u003eRonald Kiguba \u003csup\u003e4\u003c/sup\u003eJoan Nangendo; \u003csup\u003e5\u003c/sup\u003eGerald Mutungi; \u003csup\u003e1,4\u003c/sup\u003eFred C. Semitala; \u003csup\u003e1,4\u003c/sup\u003eMoses R. Kamya; and \u003csup\u003e1\u003c/sup\u003eJane Kabami.\u003c/p\u003e \u003cp\u003e \u003csup\u003e1\u003c/sup\u003eInfectious Diseases Research Collaboration (IDRC) Uganda, \u003csup\u003e2\u003c/sup\u003eUganda Heart Institute (UHI) Uganda, \u003csup\u003e3\u003c/sup\u003eInfectious Diseases Institute, Makerere University \u003csup\u003e4\u003c/sup\u003eMakerere University, Kampala, Uganda, and \u003csup\u003e5\u003c/sup\u003eMinistry of Health (MoH) Uganda.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe authors confirm their contribution to the paper as follows: MuA, GM, FCS, MRK, JN, and JK designed the study; BT, MuA, EA; supervised the study collection in the field; MuA and MiA analysed the data. MuA prepared the initial draft of this manuscript. ANK, and RK supported the writing of the first draft of this manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe authors confirm that the data supporting the findings of this study are available with the article. Raw data that supports the findings of this study are available from the corresponding author upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eXu Y, Chen X, Wang K. Global prevalence of hypertension among people living with HIV: a systematic review and meta-analysis. Journal of the American Society of Hypertension. 2017;11(8):530-40.\u003c/li\u003e\n\u003cli\u003eMarcus JL, Leyden WA, Alexeeff SE, Anderson AN, Hechter RC, Hu H, et al. Comparison of Overall and Comorbidity-Free Life Expectancy Between Insured Adults With and Without HIV Infection, 2000-2016. JAMA Network Open. 2020;3(6):e207954-e.\u003c/li\u003e\n\u003cli\u003eRoomaney RA, van Wyk B, Pillay-van Wyk V. Aging with HIV: Increased Risk of HIV Comorbidities in Older Adults. Int J Environ Res Public Health. 2022;19(4).\u003c/li\u003e\n\u003cli\u003eTegegne KD, Adela GA, Kassie GA, Mengstie MA, Seid MA, Zemene MA, et al. Prevalence and factors associated with hypertension among peoples living with HIV in East Africa, a systematic review and meta-analysis. BMC Infectious Diseases. 2023;23(1):724.\u003c/li\u003e\n\u003cli\u003eOkyere J, Ayebeng C, Owusu BA, Dickson KS. Prevalence and factors associated with hypertension among older people living with HIV in South Africa. BMC Public Health. 2022;22(1):1684.\u003c/li\u003e\n\u003cli\u003eHarimenshi D, Niyongabo T, Preux PM, Aboyans V, Desormais I. Hypertension and associated factors in HIV-infected patients receiving antiretroviral treatment in Burundi: a cross-sectional study. Sci Rep. 2022;12(1):20509.\u003c/li\u003e\n\u003cli\u003eMigisha R, Ario AR, Kadobera D, Bulage L, Katana E, Ndyabakira A, et al. High blood pressure and associated factors among HIV-infected young persons aged 13 to 25 years at selected health facilities in Rwenzori region, western Uganda, September\u0026ndash;October 2021. Clinical Hypertension. 2023;29(1):6.\u003c/li\u003e\n\u003cli\u003eByonanebye DM, Polizzotto MN, Parkes-Ratanshi R, Musaazi J, Petoumenos K, Castelnuovo B. Prevalence and incidence of hypertension in a heavily treatment-experienced cohort of people living with HIV in Uganda. PloS one. 2023;18(2):e0282001.\u003c/li\u003e\n\u003cli\u003eOrganization WH. Guideline for the pharmacological treatment of hypertension in adults: World Health Organization; 2021.\u003c/li\u003e\n\u003cli\u003eMuddu M, Ssinabulya I, Kigozi SP, Ssennyonjo R, Ayebare F, Katwesigye R, et al. 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. Implementation Science Communications. 2021;2(1):121.\u003c/li\u003e\n\u003cli\u003eKwarisiima D, Atukunda M, Owaraganise A, Chamie G, Clark T, Kabami J, et al. Hypertension control in integrated HIV and chronic disease clinics in Uganda in the SEARCH study. BMC Public Health. 2019;19(1):511.\u003c/li\u003e\n\u003cli\u003eNielsen J\u0026Oslash;, Shrestha AD, Neupane D, Kallestrup P. Non-adherence to anti-hypertensive medication in low- and middle-income countries: a systematic review and meta-analysis of 92443 subjects. Journal of Human Hypertension. 2017;31(1):14-21.\u003c/li\u003e\n\u003cli\u003eOrganization WH. The selection and use of essential medicines 2023: executive summary of the report of the 24th WHO expert committee on selection and use of essential medicines, 24\u0026ndash;28 April 2023. The selection and use of essential medicines 2023: executive summary of the report of the 24th WHO Expert Committee on Selection and Use of Essential Medicines, 24\u0026ndash;28 April 20232023.\u003c/li\u003e\n\u003cli\u003eVialle-Valentin CE, Serumaga B, Wagner AK, Ross-Degnan D. Evidence on access to medicines for chronic diseases from household surveys in five low- and middle-income countries. Health Policy and Planning. 2014;30(8):1044-52.\u003c/li\u003e\n\u003cli\u003eOlaniran A, Briggs J, Pradhan A, Bogue E, Schreiber B, Dini HS, et al. Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences. Human Resources for Health. 2022;20(1):58.\u003c/li\u003e\n\u003cli\u003eMusinguzi G, Bastiaens H, Wanyenze RK, Mukose A, Van Geertruyden J-P, Nuwaha F. Capacity of health facilities to manage hypertension in Mukono and Buikwe districts in Uganda: challenges and recommendations. PloS one. 2015;10(11):e0142312.\u003c/li\u003e\n\u003cli\u003eKatende D, Mutungi G, Baisley K, Biraro S, Ikoona E, Peck R, et al. Readiness of Ugandan health services for the management of outpatients with chronic diseases. Trop Med Int Health. 2015;20(10):1385-95.\u003c/li\u003e\n\u003cli\u003eSchwartz JI, Guwatudde D, Nugent R, Kiiza CM. Looking at non-communicable diseases in Uganda through a local lens: an analysis using locally derived data. Global Health. 2014;10:77.\u003c/li\u003e\n\u003cli\u003eArmstrong-Hough M, Kishore SP, Byakika S, Mutungi G, Nunez-Smith M, Schwartz JI. Disparities in availability of essential medicines to treat non-communicable diseases in Uganda: A Poisson analysis using the Service Availability and Readiness Assessment. PloS one. 2018;13(2):e0192332.\u003c/li\u003e\n\u003cli\u003eRogers HE, Akiteng AR, Mutungi G, Ettinger AS, Schwartz JI. Capacity of Ugandan public sector health facilities to prevent and control non-communicable diseases: an assessment based upon WHO-PEN standards. BMC Health Serv Res. 2018;18(1):606.\u003c/li\u003e\n\u003cli\u003eMedicines E. WHO Model List of Essential Medicines\u0026mdash;23rd List; 2023. 2023.\u003c/li\u003e\n\u003cli\u003eBateganya MH, Amanyeiwe U, Roxo U, Dong M. Impact of Support Groups for People Living With HIV on Clinical Outcomes: A Systematic Review of the Literature. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2015;68:S368-S74.\u003c/li\u003e\n\u003cli\u003eSimoni JM, Franks JC, Lehavot K, Yard SS. Peer interventions to promote health: conceptual considerations. American Journal of Orthopsychiatry. 2011;81(3):351.\u003c/li\u003e\n\u003cli\u003eAtukunda M, Kabami J, Mutungi G, Twinamatsiko B, Nangendo J, Shade SB, et al. Rationale and design of leveraging the HIV platform for hypertension control in Africa: protocol of a cluster-randomised controlled trial in Uganda. BMJ Open. 2022;12(12):e063227.\u003c/li\u003e\n\u003cli\u003eSchneider RH, Salerno J, Brook RD. 2020 International Society of Hypertension global hypertension practice guidelines - lifestyle modification. Journal of hypertension. 2020;38(11):2340-1.\u003c/li\u003e\n\u003cli\u003eShiner M. Defining peer education. J Adolesc. 1999;22(4):555-66.\u003c/li\u003e\n\u003cli\u003eDragomir A, C\u0026ocirc;t\u0026eacute; R, Roy L, Blais L, Lalonde L, B\u0026eacute;rard A, et al. Impact of adherence to antihypertensive agents on clinical outcomes and hospitalization costs. Med Care. 2010;48(5):418-25.\u003c/li\u003e\n\u003cli\u003eMacGregor GA, He FJ. Importance of controlling blood pressure. Climacteric. 2005;8 Suppl 3:13-8.\u003c/li\u003e\n\u003cli\u003eMburu L. Patient support groups: An innovative strategy in management of hypertension. online. 2023. Contract No.: 16 December 2023.\u003c/li\u003e\n\u003cli\u003eAfrica HAIH. MEDICINE PRICES IN UGANDA. Online; 2004.\u003c/li\u003e\n\u003cli\u003eDineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PloS one. 2019;14(8):e0220116.\u003c/li\u003e\n\u003cli\u003eMaslakpak MH, Rezaei B, Parizad N. Does family involvement in patient education improve hypertension management? A single-blind randomized, parallel group, controlled trial. Cogent Medicine. 2018;5(1):1537063.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cu\u003eTable 1: Sociodemographic and clinical characteristics in N (%), unless noted, of Persons Living with HIV with hypertension who participated in the Cross-sectional survey conducted in Southwestern Uganda from December 2022 to April 2023.\u003c/u\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.5566%;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8285%;\"\u003e\n \u003cp\u003ePeer Support Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3592%;\"\u003e\n \u003cp\u003eNot in Peer Support Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2557%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.5566%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8285%;\"\u003e\n \u003cp\u003eN=63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3592%;\"\u003e\n \u003cp\u003eN=99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2557%;\"\u003e\n \u003cp\u003eN=163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.5566%;\"\u003e\n \u003cp\u003eHealth Facility\u003c/p\u003e\n \u003cp\u003eLevel III\u003c/p\u003e\n \u003cp\u003eLevel IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (9.5%)\u003c/p\u003e\n \u003cp\u003e58 (90.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3592%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50 (50.5%)\u003c/p\u003e\n \u003cp\u003e49 (49.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2557%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56 (34.4%)\u003c/p\u003e\n \u003cp\u003e107 (65.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.5566%;\"\u003e\n \u003cp\u003eFemale, Sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8285%;\"\u003e\n \u003cp\u003e38 (60.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3592%;\"\u003e\n \u003cp\u003e52 (52.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2557%;\"\u003e\n \u003cp\u003e90 (55.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.5566%;\"\u003e\n \u003cp\u003eAge, Mean [SD]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8285%;\"\u003e\n \u003cp\u003e52.6 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3592%;\"\u003e\n \u003cp\u003e51.1 (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2557%;\"\u003e\n \u003cp\u003e51.7 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.5566%;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003cp\u003eNo school\u003c/p\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003cp\u003eTertiary/Vocational\u003c/p\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003cp\u003ePost-graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3592%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2557%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38(23.3%)\u003c/p\u003e\n \u003cp\u003e97 (59.5%)\u003c/p\u003e\n \u003cp\u003e14 (8.6%)\u003c/p\u003e\n \u003cp\u003e10 (6.1%)\u003c/p\u003e\n \u003cp\u003e3 (1.8%)\u003c/p\u003e\n \u003cp\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.5566%;\"\u003e\n \u003cp\u003eART Treatment duration\u003c/p\u003e\n \u003cp\u003eLess than a month\u003c/p\u003e\n \u003cp\u003e1-3 months\u003c/p\u003e\n \u003cp\u003e4-6 months\u003c/p\u003e\n \u003cp\u003e6-12 months\u003c/p\u003e\n \u003cp\u003e5: More than a year ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3592%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2557%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e159 (97.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.5566%;\"\u003e\n \u003cp\u003eHypertension Treatment\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePharmacological\u003c/p\u003e\n \u003cp\u003eNon-pharmacological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3592%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2557%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e162 (99.4%)\u003c/p\u003e\n \u003cp\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.5566%;\"\u003e\n \u003cp\u003eHypertension treatment duration\u003c/p\u003e\n \u003cp\u003eLess than a month\u003c/p\u003e\n \u003cp\u003e1-3 months\u003c/p\u003e\n \u003cp\u003e4-6 months\u003c/p\u003e\n \u003cp\u003e6-12 months\u003c/p\u003e\n \u003cp\u003e5: More than a year ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8285%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3592%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2557%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (1.8%)\u003c/p\u003e\n \u003cp\u003e25 (15.3%)\u003c/p\u003e\n \u003cp\u003e25 (15.3%)\u003c/p\u003e\n \u003cp\u003e33 (20.2%)\u003c/p\u003e\n \u003cp\u003e77 (47.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42.5566%;\"\u003e\n \u003cp\u003eBlood pressure control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8285%;\"\u003e\n \u003cp\u003e34 (53.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3592%;\"\u003e\n \u003cp\u003e33 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2557%;\"\u003e\n \u003cp\u003e67 (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTable 2: Number and proportion of Persons Living with HIV who attended peer support groups and participated in the Cross-sectional survey conducted in Southwestern Uganda from December 2022 to April 2023.\u003c/u\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"585\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eDuration of participation in the peer support group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003eN=63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026lt;1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e1-3 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e4-6 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e6-12 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026gt;12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eThe average amount spent monthly buying HTN medications before joining peer support group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003eN=63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026lt; $1.3 (\u0026lt;UGX5,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e$ 1.3 \u0026ndash; 2.6 (UGX 5,000-10,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e34.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e$2.6 \u0026ndash;7.8 (UGX10,000-30,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;Not spent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e\u0026nbsp;44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eThe actual amount contributed to the peer support group (Uganda shillings)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003eN=63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e$0.8 (UGX 3,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e$1.3 (UGX 5,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e$1.8 (UGX 7,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e$2.6 (UGX10,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e$5.2 (UGX 20,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e$6.5 (UGX 25,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e$7.8 (30,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eAccessibility to HTN drugs through the peer support group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003eN=63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eAffordability of the member contributions\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003eN=63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e\u0026nbsp;38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e\u0026nbsp;60.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e39.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eFrequency of contributions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003en=48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eonce a month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eonce in 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003ePatient satisfaction with the performance of the Peer support group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.71795%;\"\u003e\n \u003cp\u003eVAS Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.91453%;\"\u003e\n \u003cp\u003eVAS Scale scores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.71795%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.91453%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.71795%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.91453%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.71795%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.91453%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.71795%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.91453%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.71795%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.91453%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.71795%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.91453%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.71795%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.91453%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.71795%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.91453%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.71795%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.91453%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.71795%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9.91453%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70.9402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eActivities carried out in the Peer support group \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003eN=61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eHealth education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eHealth education \u0026amp; performing BP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eHealth education, performing BP \u0026amp; peer counselling\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eHealth education \u0026amp; peer counselling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.9402%;\"\u003e\n \u003cp\u003eHealth education \u0026amp; group financial savings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 18.6325%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.4274%;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HIV, Hypertension, Peer Support groups, Anti-Hypertensive drugs, multi-morbidity","lastPublishedDoi":"10.21203/rs.3.rs-6445280/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6445280/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: People living with HIV (PLHIV) often have poorly controlled hypertension due to medication non-adherence, primarily caused by limited access to antihypertensive drugs. Peer support groups are being explored to improve access. We evaluated the feasibility and acceptability of peer support groups to improve access to anti-hypertensive drugs for PLHIV with hypertension.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: From December 2022 to April 2023, we conducted a cross-sectional survey and measurement of blood pressure among PLHIV in 26 health facilities to assess the accessibility of anti-hypertensive drugs in the peer support groups. The collected data was summarized using descriptive statistics\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e : Eight out of 26 health facilities formed peer support groups. Among 163 PLHIV interviewed only 64 participated in the peer support groups. Among those who participated in peer support groups 57% reported accessing anti-hypertensive drugs through the group. The peer support groups were affordable for most participants. Around 60% found the contributions manageable, with 79% contributing $1.3 or less. Most participants expressed confidence in the performance of the peer support groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The results of the study suggest that patient-led peer support groups are a feasible intervention to improve access to hypertensive medications for PLHIV with Hypertension.\u003c/p\u003e","manuscriptTitle":"Patient-Led Peer Support Groups Improve Anti-Hypertensive Drugs Access For Adults Living With HIV And Hypertension In Rural Uganda – A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-18 02:18:53","doi":"10.21203/rs.3.rs-6445280/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"81635660-4d55-4c40-9804-e77c5115996b","owner":[],"postedDate":"June 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-24T12:25:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-18 02:18:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6445280","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6445280","identity":"rs-6445280","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}