Changing patterns in Health-seeking behavior and prescription practices for treatment of hypertension in nine districts – insights from India Hypertension Control Initiative, 2018-19 and 2023-24 

Changing patterns in Health-seeking behavior and prescription practices for treatment of hypertension in nine districts – insights from India Hypertension Control Initiative, 2018-19 and 2023-24 | 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 Changing patterns in Health-seeking behavior and prescription practices for treatment of hypertension in nine districts – insights from India Hypertension Control Initiative, 2018-19 and 2023-24 Prabhdeep Kaur, Kalyani Sailesh, Navaneeth S Krishna, Mosoniro Kriina, and 35 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6801552/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Oct, 2025 Read the published version in BMC Public Health → Version 1 posted 22 You are reading this latest preprint version Abstract The India Hypertension Control Initiative (IHCI) aimed to strengthen public sector primary care for hypertension treatment and control. Our study describes changes in health-seeking behavior, prescription practices, and key predictors influencing treatment adoption in the public sector using data from IHCI repeat cross-sectional surveys. We conducted baseline (2018-19) and follow-up (2023-24) surveys in nine districts across five Phase I states in India - two districts each from Punjab, Madhya Pradesh, Telangana, and Kerala, and one from Maharashtra. The study planned to include 3,900 adults (18–69 years) diagnosed with hypertension and on treatment. We computed frequencies and proportions for socio-demographic variables, healthcare utilization, blood pressure (BP) control, drug availability, medication costs, and prescription practices. We used a log-binomial model to estimate unadjusted and adjusted prevalence ratios (PRs, APRs) with 95% confidence intervals for factors influencing care-seeking for hypertension in government facilities. Among 2,873 baseline and 3,276 follow-up respondents, the proportion seeking treatment at government facilities increased from 20–32%. Individuals on treatment were 1.5 times more likely to use government facilities in 2023-24 than in 2018-19 (aPR 1.54, 95% CI: 1.4–1.7). BP control improved in government (37–48%) and non-government (35–47%) facilities. Drug availability (always available) in government facilities rose from 72% (425/588) to 81% (844/1041), with Amlodipine 5mg remaining the most prescribed drug (18%). The proportion of individuals paying for medications dropped from 47–9%. There was an increase in public sector use, improved BP control, enhanced drug availability, and reduced costs, possibly due to IHCI interventions. We recommend using representative surveys for NCD surveillance to monitor healthcare utilization patterns and assess the impact of interventions on hypertension outcomes. Figures Figure 1 Introduction Hypertension is a major risk factor for cardiovascular diseases, and an estimated 220 million Indian adults live with hypertension ( 1 ). The National NCD Monitoring Survey (NNMS-2017-2018) reported that 28.5% of the surveyed population were diagnosed with hypertension. Yet, only 27.9% were aware of their hypertension status, and 14.5% were receiving treatment, of which only 12.6% had achieved adequate control ( 2 ). The low treatment coverage and poor hypertension control rates can be attributed to multiple factors, including health-seeking behavior. While individual-level factors play a role, health system-related factors—such as the availability, accessibility, and affordability of healthcare services and essential medications—are equally significant ( 3 ). The impact of health system strengthening on improving health outcomes was previously demonstrated through government initiatives to reduce maternal mortality in India ( 4 ). Recognizing similar challenges and possibilities of decentralizing solutions in the noncommunicable disease (NCD) domain, the Ministry of Health and Family Welfare, Government of India, launched the National Programme for Prevention and Control of NCDs (NP-NCD). This initiative aims to strengthen the continuum of care by integrating screening, early detection, management, referral, and follow-up across all levels of healthcare delivery. A key component of the NP-NCD is the expansion of hypertension screening through newly upgraded sub-centers, known as Health and Wellness Centres (HWCs), which aim to enhance access to primary care services ( 5 ). However, the effective implementation of hypertension screening, diagnosis, and management continues to be hindered by systemic barriers such as inadequate availability of healthcare providers and essential antihypertensive medications ( 3 , 6 ). The India Hypertension Control Initiative (IHCI), launched under the NP-NCD, addresses these implementation challenges through a structured, evidence-based approach to improve hypertension management in primary healthcare settings. IHCI is built on five core pillars: adoption of standard treatment protocols aligned with the WHO HEARTS initiative, ensuring a consistent supply of free antihypertensive medications, promoting team-based care, emphasizing patient-centered approaches, and establishing an effective information system to monitor treatment adherence and blood pressure (BP) control. By enhancing the adoption of protocols and supply chain management, the IHCI model demonstrated that a scalable, systems-based intervention can drive significant improvements in hypertension management ( 7 ). According to the National Sample Survey Office (NSSO) survey (2017-18), nearly 70% prefer private hospitals and clinics ( 8 ), indicating a strong preference for private healthcare services due to perceived quality, despite the financial burden. However, initiatives like the IHCI aim to strengthen public healthcare systems, making them more accessible and reliable for hypertension management. The IHCI conducted serial cross-sectional surveys in 2018-19 and 2023-24 across nine districts in five Indian states to assess changes in hypertension treatment and control over time. These surveys also collected information regarding health-seeking behavior. Our study examines health-seeking behavior and prescription practices among individuals aware of and receiving treatment for hypertension, using data from the baseline and follow-up surveys in five Phase I IHCI states. We also determined key predictors influencing the adoption of the public sector for hypertension treatment in this population. Methods Under IHCI, we conducted repeat cross-sectional surveys to track trends in hypertension awareness, treatment, and control. We conducted a baseline survey between 2018 and 2019 and a follow-up survey between 2023 and 2024 in the same districts. The surveys covered nine of the 25 districts where Phase I of IHCI was implemented, including two districts each from Punjab, Madhya Pradesh, Telangana, and Kerala, and one from Maharashtra. The study population consisted of adults aged 18–69 years with a confirmed diagnosis of hypertension and who were currently on treatment. Inclusion and Exclusion Criteria Eligible households were those with a shared kitchen and at least one member aged 18–69 years who had resided there for over six months. Eligible individuals were adults aged 18–69 years present in the selected household at the survey time. We excluded households without eligible members. Individuals were excluded if they refused to participate, were unavailable after three attempts, or were ineligible due to factors like age, residency duration, pregnancy, mental disability, hearing loss, terminal illness, or inability to provide informed consent. Sample Size and Sampling Design Our survey employed a four-stage sampling strategy. First, we selected survey clusters using probability proportional to size (PPS) systematic sampling, with the number of households serving as the size measure. A census enumeration block (CEB) was chosen within each selected cluster using PPS. Subsequently, we sampled households within the selected CEB through systematic sampling. Finally, one eligible adult was randomly chosen within each selected household using simple random sampling ( 9 ). The primary outcome was controlled BP among adults with hypertension. Considering a baseline control rate of 20%, an increase to 30% at follow-up, an intra-cluster correlation coefficient of 0.04, and a design effect of 1.6 with 95% confidence and a power of 90%, we estimated a required sample size of 624 adults with hypertension for the baseline and follow-up survey. Assuming a 25% prevalence of hypertension, we aimed to survey a sample four times the expected number of individuals with hypertension. Accounting for a 20% non-response rate at household and individual levels, we estimated a total sample size of 3,900 individuals and planned to survey 100 individuals across 39 clusters in each district ( 9 ). Data Collection We collected data using Open Data Kit (ODK)-based forms on Android tablets. First, we visited households based on their unique household ID within the selected cluster. Next, from a line listing of all eligible adults in the selected household, an adult was selected by the ODK program. BP was measured twice at a five-minute interval using a professional digital BP monitor (Omron 1300). Information regarding prior diagnosis and treatment of hypertension was collected for the selected individual. We administered a detailed questionnaire to adults aged 18–69 years who exhibited raised systolic or diastolic BP in either of the two readings or had a prior diagnosis and were undergoing treatment for hypertension. We obtained data on participant’s socio-demographic profiles, the health facilities they visited for hypertension treatment, drug availability, the cost of medications and facility visits, and prescription practices. Operational definitions We defined hypertension based on the average of second and third readings. The criteria included systolic BP (SBP) > = 140 mmHg or diastolic BP (DBP) > = 90 mmHg or treatment with antihypertensive medications in the previous two weeks. Individuals who satisfied these criteria and who reported being diagnosed with hypertension by a health provider were considered to be aware of their hypertension status. Individuals on treatment included people with hypertension who had taken medications in the previous two weeks. Individuals on hypertension treatment in the past two weeks and with SBP < 140 mmHg and DBP < 90 mmHg were defined as having their BP under control. For data analysis and interpretation, we grouped private clinics, private hospitals, and alternative systems of medicine under the term ‘private health facilities.’ Statistical Analysis We exported the data collected through ODK in comma-separated value format and cleaned using Microsoft Excel. We computed frequencies and proportions for categorical socio-demographic variables like age, gender, education status, occupation status, and BMI. Additionally, we calculated the frequencies and percentages of variables such as health facility visited for hypertension care, availability of drugs in health facilities, availability of special treatment cards, number of days of prescription, user fee, payment for hypertension medication, and prescription practices. Using a log-binomial model, we calculated unadjusted prevalence ratios (PRs) with 95% confidence intervals (CIs) for seeking hypertension care in government health facilities for each covariate. We performed a univariate analysis for variables such as age (18–44; 45–59; 60–69), gender (male; female), education status (no formal schooling; middle to high school; secondary and above), and occupation status (professional/business/senior executive; agricultural landowner; skilled/unskilled manual laborer; homemaker/students; others [retired/unemployed]). We included all variables with p < 0.2 in the univariate analysis in the final model and reported adjusted prevalence ratios (APRs) with 95% CI. Statistical significance was set at p < 0.05, and we performed analyses using STATA SE (version 17.0, StataCorp LLC, Texas, USA. Results Socio-demographic characteristics and health-seeking behavior In the baseline survey, 2,873 out of 7,047 individuals with hypertension were aware and receiving treatment, compared to 3,276 out of 7,324 in the follow-up survey. The socio-demographic profile regarding age, gender distribution, education, and occupation was comparable at baseline and follow-up (Table 1 ). Table 1 Characteristics of individuals who are aware and treated for hypertension participated in baseline (2018-19) and follow-up (2023-24) surveys in five Phase I states of IHCI Demographic characteristics Baseline (N = 2,873) Follow-up (N = 3,276) n % n % Gender Male 924 32 1,103 34 Female/T 1,949 68 2,173 66 Age group in years 18–44 423 15 357 11 45–59 1,228 43 1,416 43 60–69 1,222 43 1,503 46 Education No formal schooling 786 27 900 27 Middle to High school (up to 10) 1602 56 1699 52 Secondary & above 485 17 674 21 Occupation Professional/Business/Senior Executive 375 13 466 14 Agricultural landowner 172 6 253 8 Skilled/Unskilled Manual Labourer 468 16 659 20 Homemaker/Students 1,467 51 1,507 46 Others (Retired/Unemployed) 391 14 391 12 BMI (kg/m2) Under Weight ( = 30.00 kg/m2) 623 22 639 20 We observed that in the follow-up survey conducted in 2023-24, the proportion of individuals with hypertension seeking care at various government healthcare facilities revealed an increasing trend from baseline to follow-up: 1% versus 3% for HWCs, 11% versus 20% for Primary Health Centres or Community Health Centres, and 8% versus 9% for District/Taluk Hospitals or Government Medical Colleges. Overall, the preference to seek hypertension care in private health facilities decreased from 80% (2,285/2,873) in 2018-19 to 68% (2,235/3,276) (Table 2 ). Table 2 Distribution of the recently visited health facilities by the individuals who are aware and treated for hypertension participated in baseline (2018-19) and follow-up (2023-24) surveys in five Phase I states of IHCI HWC* PHC/CHC** District/Taluk hospital/Govt. Medical College Private clinic/hospital Alternate systems of medicine & others n % n % n % n % n % Punjab Baseline (N = 847) 13 1.5 8 0.9 74 8.7 629 74.3 123 14.5 Follow up (N = 693) 35 5.1 66 9.5 66 9.5 433 62.5 93 13.4 Madhya Pradesh Baseline (N = 250) 0 0.0 39 15.6 14 5.6 194 77.6 3 1.2 Follow up (N = 432) 4 0.9 147 34.0 24 5.6 240 55.6 17 3.9 Maharashtra Baseline (N = 223) 1 0.4 10 4.5 28 12.6 184 82.5 0 0.0 Follow up (N = 316) 2 0.6 67 21.2 36 11.4 201 63.6 10 3.2 Telangana Baseline (N = 654) 10 1.5 46 7.0 38 5.8 390 59.6 170 26.0 Follow up (N = 878) 58 6.6 131 14.9 41 4.7 551 62.8 97 11.0 Kerala Baseline (N = 899) 5 0.6 213 23.7 89 9.9 542 60.3 50 5.6 Follow up (N = 957) 2 0.2 246 25.7 116 12.1 546 57.1 47 4.9 Overall Baseline (N = 2,873) 29 1.0 316 11.0 243 8.5 1939 67.5 346 12.0 Follow up (N = 3,276) 101 3.1 657 20.1 283 8.6 1971 60.2 264 8.1 *Health and Wellness Centres **Primary Health Centre/Community Health Centre The follow-up survey revealed an increase in individuals seeking hypertension care at government health facilities across several states, namely Punjab (1–10%), Madhya Pradesh (15.6–34%), Maharashtra (5–21%), and Telangana (7–15%). Additionally, a notable increase in preference for HWCs was observed in Punjab, increasing from 2% (13/847) to 5% (35/693), and in Telangana, rising from 2% (10/654) to 7% (58/878). Conversely, a decline in the preference for private health facilities was evident, particularly in Madhya Pradesh, where the preference dropped from 78% (194/250) to 56% (240/432), and from 83% (184/223) to 64% (201/316) in Maharashtra (Table 2 ). We analyzed the factors associated with seeking hypertension treatment in government health facilities in baseline and follow-up surveys. Among the individuals on treatment for hypertension, the follow-up survey showed that people were 1.5 times more likely to seek hypertension care in a government health facility compared to the baseline survey (adjusted PR: 1.5; 95% CI: 1.4–1.7) after adjusting for age, gender, education, and occupation (Table 3 ). In the follow-up survey, half of the individuals who were aware of their hypertension status reported that the most common reason for not taking medication was that they didn’t feel sick (50%; 505/1008) or drugs were not prescribed (39%; 396/1008). Table 3 Predictors of seeking treatment for hypertension among individuals on treatment for previous two weeks in government health facilities in baseline (2018-19) and follow-up (2023-24) survey in five Phase I states of IHCI N n % Unadjusted PR p value Adjusted PR* p value IHCI Round Baseline 2,873 588 20 ref ref Follow up 3,276 1,041 32 1.6(1.4–1.7) < 0.01 1.5(1.4–1.7) 0.00 Gender Male 2,027 527 26 ref ref Female/T 4,122 1,102 27 1.0(0.9–1.1) 0.54 1.0(0.9–1.1) 0.47 Age group 18–44 780 136 17 ref ref 45–59 2,644 665 25 1.4(1.2–1.7) < 0.01 1.3(1.1–1.6) 0.00 60–69 2,725 828 30 1.7(1.5–2.1) < 0.01 1.6(1.3–1.9) 0.00 Education No formal schooling 1,686 470 28 1.8(1.5–2.1) < 0.01 1.6(1.4–1.9) 0.00 Middle to High school (upto 10) 3,301 977 30 2.0(1.6–2.1) < 0.01 1.8(1.6–2.1) 0.00 Secondary & above 1,159 181 16 ref ref Occupation Professional/Business/Senior Executive 841 172 20 ref ref Agriculural land owner 425 111 26 1.3(1.0 -1.6) 0.02 1.0(0.8–1.3) 0.71 Skilled/Unskilled Manual Labourer 1,127 383 34 1.7(1.4–1.9) < 0.01 1.3(1.1–1.6) 0.00 Homemaker/Students 2,974 750 25 1.2(1.1–1.4) < 0.01 1.0(0.8–1.2) 0.78 Others (Retired/Umemployed) 782 213 27 1.3(1.1–1.6) < 0.01 1.1(0.9–1.3) 0.39 *adjusted for all variables Blood pressure (BP) control Blood pressure control among individuals on treatment improved in the government health facilities, from 37% (220/588) to 48% (498/1,041) in the follow-up survey. A similar improvement was observed in non-government health facilities, where BP control increased from 35% (803/2,285) to 47% (1,053/2,235) over the same period (Table 4 ). Table 4 Blood pressure control among individuals who are aware and treated for hypertension participated in baseline (2018-19) and follow-up (2023-24) survey in five Phase I states of IHCI Govt Non govt. N n % N n % Punjab Baseline (N = 847) 95 21 22 752 194 26 Follow up (N = 693) 167 76 46 526 228 43 Madhya Pradesh Baseline (N = 250) 53 21 40 197 53 27 Follow up (N = 432) 175 76 43 257 90 35 Maharashtra Baseline (N = 223) 39 18 46 184 91 49 Follow up (N = 316) 105 49 47 211 91 43 Telangana Baseline (N = 654) 94 38 40 560 237 42 Follow up (N = 878) 230 99 43 648 282 44 Kerala Baseline (N = 899) 307 129 42 592 228 39 Follow up (N = 957) 364 212 58 593 362 61 Overall Baseline (N = 2,873) 588 220 37 2285 803 35 Follow up (N = 3,276) 1041 498 48 2235 1053 47 Availability of drugs and cost of seeking treatment in government health facilities The availability of hypertension drugs (always available) in government health facilities improved from 72% (425/588) in 2018-19 to 81% (844/1041) in 2023-24. This increase was particularly evident in states such as Punjab (48% [46/95] to 89% [149/167]) and Telangana (63% [59/94] to 91% [210/230]) (Fig. 1 ). We observed a decrease in the proportion of individuals who paid for medications from 47% (276/588) in 2018-19 to 9% (95/1041) in 2023-24. The decline was from 63% (60/95) to 6% (10/167) in Punjab, 21% (11/53) to 5% (9/175) in Madhya Pradesh, and 64% (195/307) to 9% (32/364) in Kerala (Supplementary table 2). Prescription practices In the baseline survey, we noted that the most prescribed drug was Amlodipine 5mg (18.4%; 528/2873), followed by Amlodipine 5mg + Telmisartan 40mg combination (15.3%; 440/2873) and Telmisartan 40mg (12.6%; 361/2873). In the follow-up survey, the most prescribed drug was Amlodipine 5mg (18.5%; 606/3276), followed by Telmisartan 40mg (14.6%; 479/3276) (Table 5 ). Table 5 Drugs prescribed for individuals who are aware and treated for hypertension participated in baseline (2018-19) and follow-up (2023-24) survey in five Phase I states of IHCI Type of Drugs Baseline 2018-19 (N = 2,873) Follow up 2023-24 (N = 3,276) n % n % Amlodipine 5mg 528 18.4 606 18.5 Amlodipine 10mg 40 1.4 41 1.3 Telmisartan 40mg 361 12.6 479 14.6 Atenolol(any dose) 195 6.8 73 2.2 Losartan(any dos) 117 4.1 65 2.0 Metoprolol 50mg 23 0.8 45 1.4 Other Single Drug_bs 367 12.8 434 13.3 Amlodipine 5mg + Atenolol 50mg 18 0.6 263 8.0 Amlodipine 5mg + Telmisartan 40mg 440 15.3 178 5.4 Telmisartan 40mg + Hydrochlorothiazide 20 0.7 193 5.9 Amlodipine 5mg & Telmisartan 40mg 110 3.8 108 3.3 Other Combination Drug_bs 46 1.6 430 13.1 Two Single Drug_bs 481 16.7 150 4.6 Other multiple drugs 28 1.0 96 2.9 None 54 1.9 115 3.5 Discussion According to the Global Burden of Disease (GBD) study, hypertension accounts for over 15% of total deaths in India ( 10 ). Despite being a condition that is easy to diagnose and manage, less than one-eighth of the individuals with hypertension have the condition under control. In this study, using a systematic methodology, we documented improvements in health-seeking behavior across diverse health systems in five states, indicating progress in hypertension management. Overall, there was a shift towards higher utilization of government health facilities, accompanied by improved BP control. The improved availability of protocol drugs may have contributed to the enhanced utilization of health services. Management of hypertension in low- and middle-income countries (LMICs) is hindered by challenges such as poor access to healthcare services and medications. Research has shown that health systems in these countries are often underprepared to manage the increasing prevalence of hypertension, resulting in over two-thirds of affected individuals not receiving treatment ( 11 ). The National Noncommunicable Disease Monitoring Survey (NNMS 2017-18) noted that only one-fifth of individuals with hypertension were managed at public health facilities ( 2 ). Our baseline study showed similar results. However, the utilization of the public sector in 2023-24 increased to 32%, demonstrating that initiatives like IHCI strengthen public healthcare systems, making them more accessible and acceptable to the community. We observed the variations across different states that suggest the adoption of interventions is influenced by the local healthcare infrastructure and program implementation capacity. For instance, Kerala’s plateauing of treatment-seeking in the public sector may be attributed to its already well-established primary healthcare system ( 12 ), suggesting that people who prefer the public sector have already connected with its primary healthcare system. Conversely, states with inadequate implementation of hypertension interventions in the primary health care system before IHCI showed more notable improvements, indicating that targeted efforts in such regions can yield substantial benefits. The poor systems and lack of availability of hypertension treatment in primary care are not only limited to India but to several LMICs ( 13 – 17 ). Hence, the IHCI interventions can be considered for low-resource settings beyond India. Our study suggests a shift in healthcare utilization patterns and provides evidence that structured interventions like IHCI can enhance access to and trust in government healthcare services. In our study, the availability of hypertension medication in government health facilities has shown improvement. The availability ranged between 48–84% in 2018-19 and improved to above 72% (72–91%) across all states in 2023-24. Adopting protocols reduced the number of drugs procured in large numbers, leading to optimal stocks of Amlodipine and Telmisartan, two key medications in the IHCI treatment protocol ( 6 ). This was evident from the prescription analysis, where these two single drugs accounted for one-third of the prescriptions. The alignment between prescribed medications and protocol recommendations promotes seamless integration into the healthcare system and reinforces availability and adherence. Despite these improvements, state-wise variations in medication availability persist, emphasizing the need for a comprehensive approach to strengthen drug supply chains. We have already documented the improvement in drug availability by adopting best practices at all levels of the supply chain, from the planning phase to dispensing in resource-limited settings. Key strategies, such as selecting a standardized protocol, aligning supply with anticipated patient demand rather than relying on past increments, and utilizing straightforward stock management tools, can be replicated across districts in India to boost and maintain hypertension treatment coverage ( 6 ). Strengthening BP control in primary care is essential for reducing hypertension-related complications and improving overall healthcare outcomes. Under IHCI’s standard treatment protocol, BP control was achieved in 70% of individuals in Punjab and 76% in Maharashtra in primary care settings ( 18 ). We documented the same in a community sample, validating the results from clinic-based studies ( 18 ). Our study reported that BP control has improved in government health facilities over the years. Interestingly, BP control also improved among people taking treatment in private settings, possibly due to the broader dissemination of treatment protocols beyond the public sector, especially during the COVID-19 pandemic. The IHCI’s adaptive approach, including community-based drug distribution through HWCs/SCs and home delivery, helped expand access to hypertension care, which may have contributed to these gains in both the public and private sectors ( 19 ). The COVID-19 pandemic might have influenced doctors’ behavior and the health-seekingbehavior of people as there was more awareness regarding the need to manage NCDs to prevent COVID-19-related hospitalizations and deaths. Limitations Information on health-seeking behavior, drug availability, and medication costs was self-reported, which may introduce recall or social desirability bias. India is a diverse country, and differences in healthcare infrastructure, policies, and implementation across states could affect generalisability. We did not conduct similar surveys in districts where IHCI was not implemented. Hence, we could not provide any comparisons from such districts. Additionally, we lacked drug prescription details for 15% of individuals in the baseline survey and 4% in the follow-up survey. Conclusion and recommendations We documented the enhanced utilization of the public sector’s primary care services and improved BP control among patients on treatment. There was an improvement in the availability of drugs and reduced expenditure on treatment. IHCI strategies, which focused on improving the implementation of hypertension interventions such as protocol-based treatment, improved supply chain, and decentralized care, possibly contributed to these changes. NCD surveys in a representative sample at the district level are a useful strategy to assess healthcare utilization patterns. Gathering detailed data on health-seeking behavior, drug availability, and prescription patterns will provide valuable insights into the effectiveness of interventions and guide future strategies. Additionally, continued efforts to strengthen primary care and streamline hypertension management in private sector facilities are essential to improve equitable access and community-level control of hypertension. Abbreviations BP blood pressure CI confidence intervals IHCI India Hypertension Control Initiative LMIC low- and middle-income countries NCD noncommunicable diseases NNMS National NCD Monitoring Survey NP-NCD National Programme for Prevention and Control of Noncommunicable Diseases NSSO National Sample Survey Office NNMS National Noncommunicable Disease Monitoring Survey PR prevalence ratios aPR adjusted prevalence ratios ODK Open Data Kit WHO World Health Organisation Declarations Ethics approval and consent to participate The study was approved by the Institutional Human Ethics Committee of ICMR National Institute of Epidemiology, Chennai (NIE/IHEC/201709-02). We obtained written informed consent from the respondents before data collection. We used unique identifiers for the data collection and analysis. Identification details were not collected. Confidentiality of all the participants was maintained. Our study was conducted in compliance with the ethical principles outlined in the Declaration of Helsinki, as well as applicable national guidelines, ensuring the protection of participants' rights, safety, and well-being. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding WHO and the Indian Council of Medical Research (ICMR), India together funds IHCI project Author’s contributions PK and PG were involved in the conception and design of the study. NSK, MK, JK, MR, PKC, VV, SS, JS, SS, SB, MS, RS, PP, SDB, TC, AK, AW, RB, VB, SR, NK, BD, YP, DC, IA, SSG, AG, BG, RK, JRM, SH, NN, GSG, AKP did the acquisition of data. KS, MK, SV VV did the analysis of data. PK, KS, LK, PG have drafted the work and revised it. All the authors have approved the submitted version and have agreed to be personally accountable for the author’s own contributions and accuracy and integrity of the manuscript. Acknowledgment We acknowledge the contribution of Mr Kamaraj P, who supported the design and conduct of the study, analysis, and interpretation of this data. We also acknowledge the State and District health officials, medical officers, and ASHAs, who had supported the data collection in the communities of the states of Punjab, Maharashtra, Madhya Pradesh, Telangana and Kerala. We also acknowledge the field investigators who were involved in the data collection. References Varghese JS, Venkateshmurthy NS, Sudharsanan N, Jeemon P, Patel SA, Thirumurthy H, et al. Hypertension Diagnosis, Treatment, and Control in India. JAMA Netw Open. 2023;6(10):e2339098. Amarchand R, Kulothungan V, Krishnan A, Mathur P. Hypertension treatment cascade in India: results from National Noncommunicable Disease Monitoring Survey. 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J Hum Hypertens. 2024;1–16. van de Vijver S, Akinyi H, Oti S, Olajide A, Agyemang C, Aboderin I et al. Status report on hypertension in Africa - Consultative review for the 6th Session of the African Union Conference of Ministers of Health on NCD’s. Pan Afr Med J. 2013;16:38. India Hypertension Control Initiative. Blood Pressure Control Using Drug and Dose-Specific Standard Treatment Protocol at Scale in Punjab and Maharashtra, India, 2022 | Global Heart [Internet]. [cited 2024 Oct 8]. Available from: https://globalheartjournal.com/articles/10.5334/gh.1305 Kunwar A, Durgad K, Kaur P, Sharma M, Swasticharan L, Mallela M et al. Interventions to Ensure the Continuum of Care for Hypertension During the COVID-19 Pandemic in Five Indian States—India Hypertension Control Initiative. Glob Heart 16(1):82. Additional Declarations No competing interests reported. Supplementary Files IHCIHealthseekingbehavioursupplementary.docx Cite Share Download PDF Status: Published Journal Publication published 27 Oct, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 28 Jul, 2025 Reviewers agreed at journal 28 Jul, 2025 Reviews received at journal 26 Jul, 2025 Reviewers agreed at journal 26 Jul, 2025 Reviewers agreed at journal 25 Jul, 2025 Reviewers agreed at journal 23 Jul, 2025 Reviewers agreed at journal 22 Jul, 2025 Reviewers agreed at journal 22 Jul, 2025 Reviewers agreed at journal 17 Jul, 2025 Reviews received at journal 08 Jul, 2025 Reviews received at journal 26 Jun, 2025 Reviewers agreed at journal 22 Jun, 2025 Reviewers agreed at journal 22 Jun, 2025 Reviews received at journal 19 Jun, 2025 Reviewers agreed at journal 19 Jun, 2025 Reviewers agreed at journal 18 Jun, 2025 Reviewers agreed at journal 18 Jun, 2025 Reviewers invited by journal 18 Jun, 2025 Editor invited by journal 05 Jun, 2025 Editor assigned by journal 05 Jun, 2025 Submission checks completed at journal 05 Jun, 2025 First submitted to journal 02 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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11:08:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6801552/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6801552/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-24898-0","type":"published","date":"2025-10-27T15:58:33+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":85196547,"identity":"794a62db-9717-41b7-b47c-a1631ee5cd2e","added_by":"auto","created_at":"2025-06-23 09:38:05","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":296488,"visible":true,"origin":"","legend":"\u003cp\u003eAvailability of tablets in government health facilities as reported by individuals aware and on treatment for hypertension,\u003cbr\u003e\nin baseline (2018-19) and follow up survey (202-24), five Phase I districts, IHCI.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6801552/v1/286c01e52b54056d00839967.jpeg"},{"id":95041288,"identity":"dd0cb1e0-e0ee-493d-a630-56f1a084cff4","added_by":"auto","created_at":"2025-11-03 16:11:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1792337,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6801552/v1/83af0a26-eee4-4c93-bc46-fbb21a33db90.pdf"},{"id":85197651,"identity":"1b22bd47-80b7-43d4-b35c-e9142e9bbafe","added_by":"auto","created_at":"2025-06-23 09:46:05","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":487419,"visible":true,"origin":"","legend":"","description":"","filename":"IHCIHealthseekingbehavioursupplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-6801552/v1/750574697eccc2f3a1a7c059.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Changing patterns in Health-seeking behavior and prescription practices for treatment of hypertension in nine districts – insights from India Hypertension Control Initiative, 2018-19 and 2023-24 ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHypertension is a major risk factor for cardiovascular diseases, and an estimated 220\u0026nbsp;million Indian adults live with hypertension (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The National NCD Monitoring Survey (NNMS-2017-2018) reported that 28.5% of the surveyed population were diagnosed with hypertension. Yet, only 27.9% were aware of their hypertension status, and 14.5% were receiving treatment, of which only 12.6% had achieved adequate control (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The low treatment coverage and poor hypertension control rates can be attributed to multiple factors, including health-seeking behavior. While individual-level factors play a role, health system-related factors\u0026mdash;such as the availability, accessibility, and affordability of healthcare services and essential medications\u0026mdash;are equally significant (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The impact of health system strengthening on improving health outcomes was previously demonstrated through government initiatives to reduce maternal mortality in India (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecognizing similar challenges and possibilities of decentralizing solutions in the noncommunicable disease (NCD) domain, the Ministry of Health and Family Welfare, Government of India, launched the National Programme for Prevention and Control of NCDs (NP-NCD). This initiative aims to strengthen the continuum of care by integrating screening, early detection, management, referral, and follow-up across all levels of healthcare delivery. A key component of the NP-NCD is the expansion of hypertension screening through newly upgraded sub-centers, known as Health and Wellness Centres (HWCs), which aim to enhance access to primary care services (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, the effective implementation of hypertension screening, diagnosis, and management continues to be hindered by systemic barriers such as inadequate availability of healthcare providers and essential antihypertensive medications (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe India Hypertension Control Initiative (IHCI), launched under the NP-NCD, addresses these implementation challenges through a structured, evidence-based approach to improve hypertension management in primary healthcare settings. IHCI is built on five core pillars: adoption of standard treatment protocols aligned with the WHO HEARTS initiative, ensuring a consistent supply of free antihypertensive medications, promoting team-based care, emphasizing patient-centered approaches, and establishing an effective information system to monitor treatment adherence and blood pressure (BP) control. By enhancing the adoption of protocols and supply chain management, the IHCI model demonstrated that a scalable, systems-based intervention can drive significant improvements in hypertension management (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the National Sample Survey Office (NSSO) survey (2017-18), nearly 70% prefer private hospitals and clinics (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), indicating a strong preference for private healthcare services due to perceived quality, despite the financial burden. However, initiatives like the IHCI aim to strengthen public healthcare systems, making them more accessible and reliable for hypertension management. The IHCI conducted serial cross-sectional surveys in 2018-19 and 2023-24 across nine districts in five Indian states to assess changes in hypertension treatment and control over time. These surveys also collected information regarding health-seeking behavior.\u003c/p\u003e \u003cp\u003eOur study examines health-seeking behavior and prescription practices among individuals aware of and receiving treatment for hypertension, using data from the baseline and follow-up surveys in five Phase I IHCI states. We also determined key predictors influencing the adoption of the public sector for hypertension treatment in this population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eUnder IHCI, we conducted repeat cross-sectional surveys to track trends in hypertension awareness, treatment, and control. We conducted a baseline survey between 2018 and 2019 and a follow-up survey between 2023 and 2024 in the same districts. The surveys covered nine of the 25 districts where Phase I of IHCI was implemented, including two districts each from Punjab, Madhya Pradesh, Telangana, and Kerala, and one from Maharashtra.\u003c/p\u003e \u003cp\u003eThe study population consisted of adults aged 18\u0026ndash;69 years with a confirmed diagnosis of hypertension and who were currently on treatment.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and Exclusion Criteria\u003c/h2\u003e \u003cp\u003eEligible households were those with a shared kitchen and at least one member aged 18\u0026ndash;69 years who had resided there for over six months. Eligible individuals were adults aged 18\u0026ndash;69 years present in the selected household at the survey time.\u003c/p\u003e \u003cp\u003eWe excluded households without eligible members. Individuals were excluded if they refused to participate, were unavailable after three attempts, or were ineligible due to factors like age, residency duration, pregnancy, mental disability, hearing loss, terminal illness, or inability to provide informed consent.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample Size and Sampling Design\u003c/h3\u003e\n\u003cp\u003eOur survey employed a four-stage sampling strategy. First, we selected survey clusters using probability proportional to size (PPS) systematic sampling, with the number of households serving as the size measure. A census enumeration block (CEB) was chosen within each selected cluster using PPS. Subsequently, we sampled households within the selected CEB through systematic sampling. Finally, one eligible adult was randomly chosen within each selected household using simple random sampling (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe primary outcome was controlled BP among adults with hypertension. Considering a baseline control rate of 20%, an increase to 30% at follow-up, an intra-cluster correlation coefficient of 0.04, and a design effect of 1.6 with 95% confidence and a power of 90%, we estimated a required sample size of 624 adults with hypertension for the baseline and follow-up survey. Assuming a 25% prevalence of hypertension, we aimed to survey a sample four times the expected number of individuals with hypertension. Accounting for a 20% non-response rate at household and individual levels, we estimated a total sample size of 3,900 individuals and planned to survey 100 individuals across 39 clusters in each district (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eWe collected data using Open Data Kit (ODK)-based forms on Android tablets. First, we visited households based on their unique household ID within the selected cluster. Next, from a line listing of all eligible adults in the selected household, an adult was selected by the ODK program. BP was measured twice at a five-minute interval using a professional digital BP monitor (Omron 1300). Information regarding prior diagnosis and treatment of hypertension was collected for the selected individual.\u003c/p\u003e \u003cp\u003eWe administered a detailed questionnaire to adults aged 18\u0026ndash;69 years who exhibited raised systolic or diastolic BP in either of the two readings or had a prior diagnosis and were undergoing treatment for hypertension. We obtained data on participant\u0026rsquo;s socio-demographic profiles, the health facilities they visited for hypertension treatment, drug availability, the cost of medications and facility visits, and prescription practices.\u003c/p\u003e\n\u003ch3\u003eOperational definitions\u003c/h3\u003e\n\u003cp\u003eWe defined hypertension based on the average of second and third readings. The criteria included systolic BP (SBP)\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;140 mmHg or diastolic BP (DBP)\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;90 mmHg or treatment with antihypertensive medications in the previous two weeks. Individuals who satisfied these criteria and who reported being diagnosed with hypertension by a health provider were considered to be aware of their hypertension status. Individuals on treatment included people with hypertension who had taken medications in the previous two weeks. Individuals on hypertension treatment in the past two weeks and with SBP\u0026thinsp;\u0026lt;\u0026thinsp;140 mmHg and DBP\u0026thinsp;\u0026lt;\u0026thinsp;90 mmHg were defined as having their BP under control. For data analysis and interpretation, we grouped private clinics, private hospitals, and alternative systems of medicine under the term \u0026lsquo;private health facilities.\u0026rsquo;\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eWe exported the data collected through ODK in comma-separated value format and cleaned using Microsoft Excel. We computed frequencies and proportions for categorical socio-demographic variables like age, gender, education status, occupation status, and BMI. Additionally, we calculated the frequencies and percentages of variables such as health facility visited for hypertension care, availability of drugs in health facilities, availability of special treatment cards, number of days of prescription, user fee, payment for hypertension medication, and prescription practices.\u003c/p\u003e \u003cp\u003e Using a log-binomial model, we calculated unadjusted prevalence ratios (PRs) with 95% confidence intervals (CIs) for seeking hypertension care in government health facilities for each covariate. We performed a univariate analysis for variables such as age (18\u0026ndash;44; 45\u0026ndash;59; 60\u0026ndash;69), gender (male; female), education status (no formal schooling; middle to high school; secondary and above), and occupation status (professional/business/senior executive; agricultural landowner; skilled/unskilled manual laborer; homemaker/students; others [retired/unemployed]). We included all variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.2 in the univariate analysis in the final model and reported adjusted prevalence ratios (APRs) with 95% CI. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, and we performed analyses using STATA SE (version 17.0, StataCorp LLC, Texas, USA.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic characteristics and health-seeking behavior\u003c/h2\u003e \u003cp\u003eIn the baseline survey, 2,873 out of 7,047 individuals with hypertension were aware and receiving treatment, compared to 3,276 out of 7,324 in the follow-up survey. The socio-demographic profile regarding age, gender distribution, education, and occupation was comparable at baseline and follow-up (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of individuals who are aware and treated for hypertension participated in baseline (2018-19) and follow-up (2023-24) surveys in five Phase I states of IHCI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eDemographic characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eBaseline (N\u0026thinsp;=\u0026thinsp;2,873)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eFollow-up (N\u0026thinsp;=\u0026thinsp;3,276)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale/T\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2,173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group in years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e423\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal schooling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle to High school (up to 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1602\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary \u0026amp; above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e485\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessional/Business/Senior Executive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgricultural landowner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSkilled/Unskilled Manual Labourer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomemaker/Students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,507\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers (Retired/Unemployed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnder Weight (\u0026lt;\u0026thinsp;18.50 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal (18.50-24.99 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-obese (25.00-29.99 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObese (\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;30.00 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe observed that in the follow-up survey conducted in 2023-24, the proportion of individuals with hypertension seeking care at various government healthcare facilities revealed an increasing trend from baseline to follow-up: 1% versus 3% for HWCs, 11% versus 20% for Primary Health Centres or Community Health Centres, and 8% versus 9% for District/Taluk Hospitals or Government Medical Colleges. Overall, the preference to seek hypertension care in private health facilities decreased from 80% (2,285/2,873) in 2018-19 to 68% (2,235/3,276) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of the recently visited health facilities by the individuals who are aware and treated for hypertension participated in baseline (2018-19) and follow-up (2023-24) surveys in five Phase I states of IHCI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eHWC*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ePHC/CHC**\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eDistrict/Taluk hospital/Govt. Medical College\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003ePrivate clinic/hospital\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003eAlternate systems of medicine \u0026amp; others\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePunjab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;847)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e74.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;693)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e433\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMadhya Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;250)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e77.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;432)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e55.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaharashtra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;223)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e82.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;316)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e63.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTelangana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;654)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e59.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;878)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e551\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e62.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKerala\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;899)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e60.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;957)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;2,873)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1939\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e67.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;3,276)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e60.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e \u003cp\u003e*Health and Wellness Centres **Primary Health Centre/Community Health Centre\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe follow-up survey revealed an increase in individuals seeking hypertension care at government health facilities across several states, namely Punjab (1\u0026ndash;10%), Madhya Pradesh (15.6\u0026ndash;34%), Maharashtra (5\u0026ndash;21%), and Telangana (7\u0026ndash;15%). Additionally, a notable increase in preference for HWCs was observed in Punjab, increasing from 2% (13/847) to 5% (35/693), and in Telangana, rising from 2% (10/654) to 7% (58/878). Conversely, a decline in the preference for private health facilities was evident, particularly in Madhya Pradesh, where the preference dropped from 78% (194/250) to 56% (240/432), and from 83% (184/223) to 64% (201/316) in Maharashtra (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe analyzed the factors associated with seeking hypertension treatment in government health facilities in baseline and follow-up surveys. Among the individuals on treatment for hypertension, the follow-up survey showed that people were 1.5 times more likely to seek hypertension care in a government health facility compared to the baseline survey (adjusted PR: 1.5; 95% CI: 1.4\u0026ndash;1.7) after adjusting for age, gender, education, and occupation (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In the follow-up survey, half of the individuals who were aware of their hypertension status reported that the most common reason for not taking medication was that they didn\u0026rsquo;t feel sick (50%; 505/1008) or drugs were not prescribed (39%; 396/1008).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of seeking treatment for hypertension among individuals on treatment for previous two weeks in government health facilities in baseline (2018-19) and follow-up (2023-24) survey in five Phase I states of IHCI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnadjusted PR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAdjusted PR*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIHCI Round\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.6(1.4\u0026ndash;1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.5(1.4\u0026ndash;1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale/T\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0(0.9\u0026ndash;1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.0(0.9\u0026ndash;1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.4(1.2\u0026ndash;1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.3(1.1\u0026ndash;1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.7(1.5\u0026ndash;2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.6(1.3\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal schooling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.8(1.5\u0026ndash;2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.6(1.4\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle to High school (upto 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.0(1.6\u0026ndash;2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.8(1.6\u0026ndash;2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary \u0026amp; above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessional/Business/Senior Executive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgriculural land owner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e425\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3(1.0 -1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.0(0.8\u0026ndash;1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSkilled/Unskilled Manual Labourer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.7(1.4\u0026ndash;1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.3(1.1\u0026ndash;1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomemaker/Students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.2(1.1\u0026ndash;1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.0(0.8\u0026ndash;1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers (Retired/Umemployed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3(1.1\u0026ndash;1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.1(0.9\u0026ndash;1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e*adjusted for all variables\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eBlood pressure (BP) control\u003c/h3\u003e\n\u003cp\u003eBlood pressure control among individuals on treatment improved in the government health facilities, from 37% (220/588) to 48% (498/1,041) in the follow-up survey. A similar improvement was observed in non-government health facilities, where BP control increased from 35% (803/2,285) to 47% (1,053/2,235) over the same period (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBlood pressure control among individuals who are aware and treated for hypertension participated in baseline (2018-19) and follow-up (2023-24) survey in five Phase I states of IHCI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eGovt\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eNon govt.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePunjab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;847)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e752\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;693)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMadhya Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;250)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;432)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaharashtra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;223)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;316)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTelangana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;654)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;878)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKerala\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;899)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;957)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;2,873)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow up\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;3,276)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAvailability of drugs and cost of seeking treatment in government health facilities\u003c/h2\u003e \u003cp\u003eThe availability of hypertension drugs (always available) in government health facilities improved from 72% (425/588) in 2018-19 to 81% (844/1041) in 2023-24. This increase was particularly evident in states such as Punjab (48% [46/95] to 89% [149/167]) and Telangana (63% [59/94] to 91% [210/230]) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWe observed a decrease in the proportion of individuals who paid for medications from 47% (276/588) in 2018-19 to 9% (95/1041) in 2023-24. The decline was from 63% (60/95) to 6% (10/167) in Punjab, 21% (11/53) to 5% (9/175) in Madhya Pradesh, and 64% (195/307) to 9% (32/364) in Kerala (Supplementary table 2).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePrescription practices\u003c/h2\u003e \u003cp\u003eIn the baseline survey, we noted that the most prescribed drug was Amlodipine 5mg (18.4%; 528/2873), followed by Amlodipine 5mg\u0026thinsp;+\u0026thinsp;Telmisartan 40mg combination (15.3%; 440/2873) and Telmisartan 40mg (12.6%; 361/2873). In the follow-up survey, the most prescribed drug was Amlodipine 5mg (18.5%; 606/3276), followed by Telmisartan 40mg (14.6%; 479/3276) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDrugs prescribed for individuals who are aware and treated for hypertension participated in baseline (2018-19) and follow-up (2023-24) survey in five Phase I states of IHCI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of Drugs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBaseline 2018-19 (N\u0026thinsp;=\u0026thinsp;2,873)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eFollow up 2023-24 (N\u0026thinsp;=\u0026thinsp;3,276)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmlodipine 5mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e606\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmlodipine 10mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTelmisartan 40mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtenolol(any dose)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLosartan(any dos)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetoprolol 50mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Single Drug_bs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmlodipine 5mg\u0026thinsp;+\u0026thinsp;Atenolol 50mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmlodipine 5mg\u0026thinsp;+\u0026thinsp;Telmisartan 40mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e440\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTelmisartan 40mg\u0026thinsp;+\u0026thinsp;Hydrochlorothiazide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmlodipine 5mg \u0026amp; Telmisartan 40mg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Combination Drug_bs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo Single Drug_bs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther multiple drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAccording to the Global Burden of Disease (GBD) study, hypertension accounts for over 15% of total deaths in India (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Despite being a condition that is easy to diagnose and manage, less than one-eighth of the individuals with hypertension have the condition under control. In this study, using a systematic methodology, we documented improvements in health-seeking behavior across diverse health systems in five states, indicating progress in hypertension management. Overall, there was a shift towards higher utilization of government health facilities, accompanied by improved BP control. The improved availability of protocol drugs may have contributed to the enhanced utilization of health services.\u003c/p\u003e \u003cp\u003eManagement of hypertension in low- and middle-income countries (LMICs) is hindered by challenges such as poor access to healthcare services and medications. Research has shown that health systems in these countries are often underprepared to manage the increasing prevalence of hypertension, resulting in over two-thirds of affected individuals not receiving treatment (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The National Noncommunicable Disease Monitoring Survey (NNMS 2017-18) noted that only one-fifth of individuals with hypertension were managed at public health facilities (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Our baseline study showed similar results. However, the utilization of the public sector in 2023-24 increased to 32%, demonstrating that initiatives like IHCI strengthen public healthcare systems, making them more accessible and acceptable to the community.\u003c/p\u003e \u003cp\u003e We observed the variations across different states that suggest the adoption of interventions is influenced by the local healthcare infrastructure and program implementation capacity. For instance, Kerala\u0026rsquo;s plateauing of treatment-seeking in the public sector may be attributed to its already well-established primary healthcare system (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), suggesting that people who prefer the public sector have already connected with its primary healthcare system. Conversely, states with inadequate implementation of hypertension interventions in the primary health care system before IHCI showed more notable improvements, indicating that targeted efforts in such regions can yield substantial benefits. The poor systems and lack of availability of hypertension treatment in primary care are not only limited to India but to several LMICs (\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Hence, the IHCI interventions can be considered for low-resource settings beyond India. Our study suggests a shift in healthcare utilization patterns and provides evidence that structured interventions like IHCI can enhance access to and trust in government healthcare services.\u003c/p\u003e \u003cp\u003eIn our study, the availability of hypertension medication in government health facilities has shown improvement. The availability ranged between 48\u0026ndash;84% in 2018-19 and improved to above 72% (72\u0026ndash;91%) across all states in 2023-24. Adopting protocols reduced the number of drugs procured in large numbers, leading to optimal stocks of Amlodipine and Telmisartan, two key medications in the IHCI treatment protocol (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This was evident from the prescription analysis, where these two single drugs accounted for one-third of the prescriptions. The alignment between prescribed medications and protocol recommendations promotes seamless integration into the healthcare system and reinforces availability and adherence. Despite these improvements, state-wise variations in medication availability persist, emphasizing the need for a comprehensive approach to strengthen drug supply chains. We have already documented the improvement in drug availability by adopting best practices at all levels of the supply chain, from the planning phase to dispensing in resource-limited settings. Key strategies, such as selecting a standardized protocol, aligning supply with anticipated patient demand rather than relying on past increments, and utilizing straightforward stock management tools, can be replicated across districts in India to boost and maintain hypertension treatment coverage (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStrengthening BP control in primary care is essential for reducing hypertension-related complications and improving overall healthcare outcomes. Under IHCI\u0026rsquo;s standard treatment protocol, BP control was achieved in 70% of individuals in Punjab and 76% in Maharashtra in primary care settings (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). We documented the same in a community sample, validating the results from clinic-based studies (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Our study reported that BP control has improved in government health facilities over the years. Interestingly, BP control also improved among people taking treatment in private settings, possibly due to the broader dissemination of treatment protocols beyond the public sector, especially during the COVID-19 pandemic. The IHCI\u0026rsquo;s adaptive approach, including community-based drug distribution through HWCs/SCs and home delivery, helped expand access to hypertension care, which may have contributed to these gains in both the public and private sectors (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The COVID-19 pandemic might have influenced doctors\u0026rsquo; behavior and the health-seekingbehavior of people as there was more awareness regarding the need to manage NCDs to prevent COVID-19-related hospitalizations and deaths.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eInformation on health-seeking behavior, drug availability, and medication costs was self-reported, which may introduce recall or social desirability bias. India is a diverse country, and differences in healthcare infrastructure, policies, and implementation across states could affect generalisability. We did not conduct similar surveys in districts where IHCI was not implemented. Hence, we could not provide any comparisons from such districts. Additionally, we lacked drug prescription details for 15% of individuals in the baseline survey and 4% in the follow-up survey.\u003c/p\u003e \u003c/div\u003e "},{"header":"Conclusion and recommendations","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003cp\u003eWe documented the enhanced utilization of the public sector\u0026rsquo;s primary care services and improved BP control among patients on treatment. There was an improvement in the availability of drugs and reduced expenditure on treatment. IHCI strategies, which focused on improving the implementation of hypertension interventions such as protocol-based treatment, improved supply chain, and decentralized care, possibly contributed to these changes.\u003c/p\u003e \u003cp\u003eNCD surveys in a representative sample at the district level are a useful strategy to assess healthcare utilization patterns. Gathering detailed data on health-seeking behavior, drug availability, and prescription patterns will provide valuable insights into the effectiveness of interventions and guide future strategies. Additionally, continued efforts to strengthen primary care and streamline hypertension management in private sector facilities are essential to improve equitable access and community-level control of hypertension.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;blood pressure\u003c/p\u003e\n\u003cp\u003eCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;confidence intervals\u003c/p\u003e\n\u003cp\u003eIHCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;India Hypertension Control Initiative\u003c/p\u003e\n\u003cp\u003eLMIC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;low- and middle-income countries\u003c/p\u003e\n\u003cp\u003eNCD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;noncommunicable diseases\u003c/p\u003e\n\u003cp\u003eNNMS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;National NCD Monitoring Survey\u003c/p\u003e\n\u003cp\u003eNP-NCD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;National Programme for Prevention and Control of Noncommunicable Diseases\u003c/p\u003e\n\u003cp\u003eNSSO\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;National Sample Survey Office\u003c/p\u003e\n\u003cp\u003eNNMS National Noncommunicable Disease Monitoring Survey\u003c/p\u003e\n\u003cp\u003ePR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;prevalence ratios\u003c/p\u003e\n\u003cp\u003eaPR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;adjusted prevalence ratios\u003c/p\u003e\n\u003cp\u003eODK\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Open Data Kit\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;World Health Organisation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Human Ethics Committee of ICMR National Institute of Epidemiology, Chennai (NIE/IHEC/201709-02). We obtained written informed consent from the respondents before data collection. We used unique identifiers for the data collection and analysis. Identification details were not collected. Confidentiality of all the participants was maintained. \u0026nbsp;Our study was conducted in compliance with the ethical principles outlined in the Declaration of Helsinki, as well as applicable national guidelines, ensuring the protection of participants\u0026apos; rights, safety, and well-being.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWHO and the Indian Council of Medical Research (ICMR), India together funds IHCI project\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePK and PG were involved in the conception and design of the study. \u0026nbsp;NSK, MK, JK, MR, PKC, VV, SS, JS, SS, SB, MS, RS, PP, SDB, TC, AK, AW, RB, VB, SR, NK, BD, YP, DC, IA, SSG, AG, BG, RK, JRM, SH, NN, GSG, AKP did the acquisition of data. KS, MK, SV VV did the analysis of data. PK, KS, LK, PG have drafted the work and revised it. All the authors have approved the submitted version and have agreed to be personally accountable for the author\u0026rsquo;s own contributions and accuracy and integrity of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the contribution of Mr Kamaraj P, who supported the design and\u003c/p\u003e\n\u003cp\u003econduct of the study, analysis, and interpretation of this data. We also acknowledge the State\u003c/p\u003e\n\u003cp\u003eand District health officials, medical officers, and ASHAs, who had supported the data\u003c/p\u003e\n\u003cp\u003ecollection in the communities of the states of Punjab, Maharashtra, Madhya Pradesh,\u003c/p\u003e\n\u003cp\u003eTelangana and Kerala. We also acknowledge the field investigators who were involved in the\u003c/p\u003e\n\u003cp\u003edata collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVarghese JS, Venkateshmurthy NS, Sudharsanan N, Jeemon P, Patel SA, Thirumurthy H, et al. Hypertension Diagnosis, Treatment, and Control in India. JAMA Netw Open. 2023;6(10):e2339098.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmarchand R, Kulothungan V, Krishnan A, Mathur P. Hypertension treatment cascade in India: results from National Noncommunicable Disease Monitoring Survey. J Hum Hypertens. 2023;37(5):394\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrishnan A, Mathur P, Kulothungan V, Salve HR, Leburu S, Amarchand R, et al. Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS). BMC Health Serv Res. 2021;21(1):757.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehta BS, Alambusha R, Misra A, Mehta N, Madan A. Assessment of utilisation of government programmes and services by pregnant women in India. PLoS ONE. 2023;18(10):e0285715.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoogle Docs [Internet]. [cited 2025 Feb 19]. Revised_Operational_Guidelines_of_NP_NCD_2023_2030__1719670989.pdf. 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The India Hypertension Control Initiative\u0026ndash;early outcomes in 26 districts across five states of India, 2018\u0026ndash;2020. J Hum Hypertens. 2023;37(7):560.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e2017 \u0026ndash; Household social consumption in India: Health NSS 75th round (July, June. 2018) [Internet]. [cited 2025 Feb 19]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pib.gov.in/pib.gov.in/Pressreleaseshare.aspx?PRID=1593246\u003c/span\u003e\u003cspan address=\"https://pib.gov.in/pib.gov.in/Pressreleaseshare.aspx?PRID=1593246\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaur P, Pattabi K, Gunasekaran A, Venkatasamy V, Sivalingam A, Ramasamy S et al. Population-based surveillance for hypertension awareness, treatment, and control in nine districts - India Hypertension Control Initiative, 2018\u0026ndash;19. J Hum Hypertens. 2025;1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInstitute for Health Metrics and Evaluation [Internet]. [cited 2024 Sep 11]. GBD Compare. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://vizhub.healthdata.org/gbd-compare\u003c/span\u003e\u003cspan address=\"http://vizhub.healthdata.org/gbd-compare\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlobal epidemiology. health burden and effective interventions for elevated blood pressure and hypertension. Nat Reviews Cardiol. 2021;18(11):785\u0026ndash;802.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSankar DH, Joseph J, Benny G, Nambiar D. Of primary health care reforms and pandemic responses: understanding perspectives of health system actors in Kerala before and during COVID-19. BMC Prim Care. 2023;24(1):59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElnaem MH, Mosaad M, Abdelaziz DH, Mansour NO, Usman A, Elrggal ME, et al. Disparities in Prevalence and Barriers to Hypertension Control: A Systematic Review. Int J Environ Res Public Health. 2022;19(21):14571.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchutte AE, Venkateshmurthy NS, Mohan S, Prabhakaran D. Hypertension in Low- and Middle-Income Countries. Circ Res. 2021;128(7):808\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eByiringiro S, Hinneh T, Chepkorir J, Tomiwa T, Commodore-Mensah Y, Marsteller J et al. Healthcare system barriers and facilitators to hypertension management in Ghana. Ann Glob Health 90(1):38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGafane-Matemane LF, Craig A, Kruger R, Alaofin OS, Ware LJ, Jones ESW et al. Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities. J Hum Hypertens. 2024;1\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan de Vijver S, Akinyi H, Oti S, Olajide A, Agyemang C, Aboderin I et al. Status report on hypertension in Africa - Consultative review for the 6th Session of the African Union Conference of Ministers of Health on NCD\u0026rsquo;s. Pan Afr Med J. 2013;16:38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIndia Hypertension Control Initiative. Blood Pressure Control Using Drug and Dose-Specific Standard Treatment Protocol at Scale in Punjab and Maharashtra, India, 2022 | Global Heart [Internet]. [cited 2024 Oct 8]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://globalheartjournal.com/articles/10.5334/gh.1305\u003c/span\u003e\u003cspan address=\"https://globalheartjournal.com/articles/10.5334/gh.1305\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKunwar A, Durgad K, Kaur P, Sharma M, Swasticharan L, Mallela M et al. Interventions to Ensure the Continuum of Care for Hypertension During the COVID-19 Pandemic in Five Indian States\u0026mdash;India Hypertension Control Initiative. Glob Heart 16(1):82.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6801552/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6801552/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe India Hypertension Control Initiative (IHCI) aimed to strengthen public sector primary care for hypertension treatment and control. Our study describes changes in health-seeking behavior, prescription practices, and key predictors influencing treatment adoption in the public sector using data from IHCI repeat cross-sectional surveys. We conducted baseline (2018-19) and follow-up (2023-24) surveys in nine districts across five Phase I states in India - two districts each from Punjab, Madhya Pradesh, Telangana, and Kerala, and one from Maharashtra. The study planned to include 3,900 adults (18\u0026ndash;69 years) diagnosed with hypertension and on treatment. We computed frequencies and proportions for socio-demographic variables, healthcare utilization, blood pressure (BP) control, drug availability, medication costs, and prescription practices. We used a log-binomial model to estimate unadjusted and adjusted prevalence ratios (PRs, APRs) with 95% confidence intervals for factors influencing care-seeking for hypertension in government facilities. Among 2,873 baseline and 3,276 follow-up respondents, the proportion seeking treatment at government facilities increased from 20\u0026ndash;32%. Individuals on treatment were 1.5 times more likely to use government facilities in 2023-24 than in 2018-19 (aPR 1.54, 95% CI: 1.4\u0026ndash;1.7). BP control improved in government (37\u0026ndash;48%) and non-government (35\u0026ndash;47%) facilities. Drug availability (always available) in government facilities rose from 72% (425/588) to 81% (844/1041), with Amlodipine 5mg remaining the most prescribed drug (18%). The proportion of individuals paying for medications dropped from 47\u0026ndash;9%. There was an increase in public sector use, improved BP control, enhanced drug availability, and reduced costs, possibly due to IHCI interventions. We recommend using representative surveys for NCD surveillance to monitor healthcare utilization patterns and assess the impact of interventions on hypertension outcomes.\u003c/p\u003e","manuscriptTitle":"Changing patterns in Health-seeking behavior and prescription practices for treatment of hypertension in nine districts – insights from India Hypertension Control Initiative, 2018-19 and 2023-24 ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-23 09:38:00","doi":"10.21203/rs.3.rs-6801552/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision 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