{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:34:48Z","timestamp":1790163288736,"version":"4.1.0"},"reference-count":43,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01\u2010AI150510"],"award-info":[{"award-number":["U01\u2010AI150510"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23HL162578"],"award-info":[{"award-number":["K23HL162578"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Clinic\u2010based hypertension screening and treatment for people with and without HIV depends on consistent clinic engagement. Retention is challenging in rural areas, especially for people with severe hypertension, which typically requires more frequent visits than clinically stable HIV. We hypothesised that Ministry of Health (MoH) community health workers (CHWs) could improve severe hypertension detection and treatment through an integrated hypertension\/HIV intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In rural Uganda and Kenya, we added HIV testing and a status\u2010neutral hypertension intervention to CHW workflow in an ongoing cluster\u2010randomised population\u2010level study (SEARCH:NCT05768763). Data spans March 2023\u2013August 2024. Trained CHWs screened all adults aged \u2265\u00a040 years in intervention communities for hypertension, referring those with blood pressure (BP) \u2265\u00a0140\/90 mmHg to MoH HIV\/primary care clinics. After initial in\u2010clinic evaluation, adults with BP \u2265\u00a0160\/100 mmHg were offered choice of clinic\u2010based or telehealth (CHW home visit, clinician telehealth evaluation, medication delivery) follow\u2010up care. Telehealth used a MoH\u2010compatible CHW smartphone app that syncs with electronic clinic records, prompts CHW follow\u2010up visits and facilitates clinician telehealth assessment\/medication prescribing. We report hypertension control achieved through the implementation of CHW\u2010supported screening and telehealth and used targeted minimum loss\u2010based estimation to estimate the change in population prevalence of uncontrolled hypertension from baseline to 1 year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Across eight communities, 198 CHWs measured BP in 14,378\/15,879 adults aged \u2265\u00a040 years at baseline (91%) and 13,334\/15,879 after 1 year (84%); 55% were female and 19% living with HIV. Estimated population prevalence of BP \u2265\u00a0140\/90 mmHg decreased from 16.0% at baseline to 6.4% at year 1 (9.6% absolute decrease, 95% CI 8.6%, 10.6%). Among people with HIV aged \u2265\u00a040 years (<jats:italic>n<\/jats:italic> = 3036), the prevalence of BP \u2265\u00a0140\/90 mmHg decreased from 10.5% to 4.7% (5.9% absolute decrease, 95% CI 3.0%, 8.8%). In the subset with BP \u2265\u00a0160\/100 who enrolled in the intervention (<jats:italic>n<\/jats:italic> = 919), 96% received antihypertensive medication, 81% were retained in care at 1 year and 79% achieved BP control; people with HIV (<jats:italic>n<\/jats:italic> = 120) had similar retention (80%) and BP control (80%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Within the context of a pragmatic trial, leveraging existing CHWs in an integrated HIV\/hypertension model reduced the population\u2010level prevalence of uncontrolled hypertension by 60% among people with and without HIV, extending health services into the community at scale.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26500","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T10:30:46Z","timestamp":1751884246000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A prospective cohort study of the SEARCH integrated HIV\/hypertension community health worker\u2010led intervention in rural Kenya and Uganda"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8913-1602","authenticated-orcid":false,"given":"Matthew D.","family":"Hickey","sequence":"first","affiliation":[{"name":"Division of HIV, Infectious Disease, &amp; 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