{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T18:09:52Z","timestamp":1789150192336,"version":"build-2803163510"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["5U24HL154426-05"],"award-info":[{"award-number":["5U24HL154426-05"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypertension (HTN) constitutes a major and growing public health challenge in South Africa, a setting where HIV prevalence also remains high. Despite this dual burden, longitudinal evidence describing how individuals move through the HTN care cascade particularly comparing people living with HIV (PLHIV) and people not living with HIV (PNLHIV) remains limited. Understanding patterns of progression and regression across the cascade is essential to inform health system strategies for integrated chronic disease management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>We conducted a longitudinal secondary analysis using data collected from the iHEART-SA trial, implemented across nine public primary healthcare clinics in Johannesburg between August 2022 and May 2024, with follow-up through May 2025. Adults (\u226518 years) receiving chronic care, with a known HIV status and a completed medical file review were included. Progression and regression were assessed across the HTN care cascade.<\/jats:p>\n                    <jats:p>\n                      Of 23,855 participants, 78.5% were PLHIV (median age 42 years, IQR 36\u201349; 69% female). The median SBP was 132 mmHg (IQR: 120\u2013145 mmHg). Along the HTN care cascade, PLHIV were substantially more likely to remain undiagnosed compared with PNLHIV (aRR 3.40; 95% [CI 2.45, 4.73];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Among those treated, PLHIV were less likely to achieve BP control (aRR 0.85; 95% [CI 0.75, 0.97];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012). During follow-up, PLHIV experienced higher rates of cascade regression, including regression to untreated HTN (22% versus 11%; aRR 1.51; 95% [CI 1.03, 2.23];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.037) and from controlled to uncontrolled BP (aRR 1.10; 95% [CI 1.02, 1.18];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010).\n                    <\/jats:p>\n                    <jats:p>The main study limitations were the use of routinely collected clinical data, variable follow-up, and treatment ascertainment based on documented medication use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PLHIV had lower HTN diagnosis and higher regression, including treatment discontinuation and loss of BP control, underscoring persistent gaps in longitudinal HTN management within HIV programmes and the need for integrated and targeted chronic care models that ensure treatment continuity and sustained control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004957","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:36:10Z","timestamp":1789148170000},"page":"e1004957","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The longitudinal care cascade for hypertension in people with and without HIV in South Africa: A clinic-based observational study"],"prefix":"10.1371","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7870-1363","authenticated-orcid":true,"given":"Siphamandla Bonga","family":"Gumede","sequence":"first","affiliation":[{"name":"University of the Witwatersrand","place":["Johannesburg, South Africa"],"department":["Ezintsha, Faculty of Health Sciences"]},{"name":"University of the Witwatersrand","place":["Johannesburg, South Africa"],"department":["Health Sciences Research Office (HSRO), Faculty of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9295-0035","authenticated-orcid":true,"given":"Jennifer","family":"Manne-Goehler","sequence":"additional","affiliation":[{"name":"Harvard Medical School","place":["Boston, Massachusetts, United States of America"],"department":["Division of Infectious Diseases, Brigham and Women\u2019s Hospital"]},{"name":"School of Public Health, University of the Witwatersrand","place":["Johannesburg, South Africa"],"department":["MRC\/Wits Rural Public Health and Health Transitions Research Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0246-5595","authenticated-orcid":true,"given":"Elizabeth","family":"Kelechi Oladimeji","sequence":"additional","affiliation":[{"name":"University of the Witwatersrand","place":["Johannesburg, South Africa"],"department":["Ezintsha, Faculty of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9699-3937","authenticated-orcid":true,"given":"Nicola","family":"Bulled","sequence":"additional","affiliation":[{"name":"University of Connecticut","place":["Storrs, Connecticut, United States of America"],"department":["Institute for Collaboration on Health, Intervention and Policy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7746-0668","authenticated-orcid":true,"given":"Alana T.","family":"Brennan","sequence":"additional","affiliation":[{"name":"Boston University School of Public Health","place":["Boston, Massachusetts, United States of America"],"department":["Department of Global Health"]},{"name":"Boston University School of Public Health","place":["Boston, Massachusetts, United States of America"],"department":["Department of Epidemiology"]},{"name":"University of the Witwatersrand","place":["Johannesburg, South Africa"],"department":["Health Economics and Epidemiology Research Office, Faculty of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3597-1643","authenticated-orcid":true,"given":"Samanta Tresha","family":"Lalla-Edward","sequence":"additional","affiliation":[{"name":"University of the Witwatersrand","place":["Johannesburg, South Africa"],"department":["Ezintsha, Faculty of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"pmed.1004957.ref001","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/s12916-014-0125-2","article-title":"Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study","volume":"12","author":"RN Peck","year":"2014","journal-title":"BMC 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village","volume":"10","author":"CA Metcalf","year":"1996","journal-title":"J Hum Hypertens"},{"issue":"18","key":"pmed.1004957.ref009","doi-asserted-by":"crossref","first-page":"11196","DOI":"10.3390\/ijerph191811196","article-title":"Risk factors attributable to hypertension among HIV-infected patients on antiretroviral therapy in selected rural districts of the Eastern Cape Province, South Africa","volume":"19","author":"U Tsuro","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"2","key":"pmed.1004957.ref010","article-title":"Hypertension in the South African public healthcare system: a cost-of-illness and burden of disease study","volume":"12","author":"CN Kohli-Lynch","year":"2022","journal-title":"BMJ Open"},{"issue":"10199","key":"pmed.1004957.ref011","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/S0140-6736(19)30955-9","article-title":"The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study 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control","volume":"18","author":"G Wozniak","year":"2016","journal-title":"J Clin Hypertens (Greenwich)"},{"issue":"1","key":"pmed.1004957.ref015","doi-asserted-by":"crossref","DOI":"10.1186\/s43058-024-00640-6","article-title":"Integrating hypertension detection and management in HIV care in South Africa: protocol for a stepped-wedged cluster randomized effectiveness-implementation hybrid trial","volume":"5","author":"KI Galaviz","year":"2024","journal-title":"Implement Sci Commun"},{"issue":"7","key":"pmed.1004957.ref016","article-title":"A modified Poisson regression approach to prospective studies with binary data","volume":"159","author":"G Zou","year":"2004","journal-title":"Am J Epidemiol"},{"issue":"2","key":"pmed.1004957.ref017","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1038\/s41371-018-0125-3","article-title":"Predictors of hypertension awareness, treatment and control in South Africa: results from the WHO-SAGE population survey (Wave 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Africa","volume":"22","author":"J Manne-Goehler","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"pmed.1004957.ref024","volume-title":"Adherence to long-term therapies: evidence for action","author":"E Sabate","year":"2003"},{"issue":"6","key":"pmed.1004957.ref025","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1038\/jhh.2015.97","article-title":"Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy: a systematic review with meta-analysis","volume":"30","author":"CU Nduka","year":"2016","journal-title":"J Hum Hypertens"},{"key":"pmed.1004957.ref026","doi-asserted-by":"crossref","first-page":"137460","DOI":"10.1155\/2012\/137460","article-title":"Strengthening health systems for chronic care: leveraging HIV programs to support diabetes services in Ethiopia and Swaziland","volume":"2012","author":"M Rabkin","year":"2012","journal-title":"J Trop 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Price","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"3","key":"pmed.1004957.ref030","doi-asserted-by":"crossref","first-page":"51","DOI":"10.12775\/JEHS.2023.13.03.007","article-title":"Gender differences in hypertension awareness, diagnosis and treatment","volume":"13","author":"M Janczewska","year":"2023","journal-title":"J Educ Health Sport"},{"issue":"1","key":"pmed.1004957.ref031","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s12265-019-09888-z","article-title":"Gender differences in hypertension","volume":"13","author":"J-J Song","year":"2020","journal-title":"J Cardiovasc Transl Res"},{"key":"pmed.1004957.ref032","doi-asserted-by":"crossref","first-page":"960336","DOI":"10.3389\/fcvm.2022.960336","article-title":"Sex differences in hypertension. Do we need a sex-specific guideline?","volume":"9","author":"R C\u00edfkov\u00e1","year":"2022","journal-title":"Front Cardiovasc Med"},{"issue":"6","key":"pmed.1004957.ref033","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCULATIONAHA.115.018912","article-title":"Global disparities of hypertension prevalence and control","volume":"134","author":"KT Mills","year":"2016","journal-title":"Circulation"},{"key":"pmed.1004957.ref034","article-title":"Prevalence, awareness, treatment, and control of hypertension in young adults (20\u201339 years) in Kerala, South India","author":"Z Geevar","year":"2022","journal-title":"Front Cardiovasc Med"},{"issue":"1","key":"pmed.1004957.ref035","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s12981-021-00387-3","article-title":"Treatment outcomes among adults with HIV\/non-communicable disease multimorbidity attending integrated care clubs in Cape Town, South Africa","volume":"18","author":"B Gausi","year":"2021","journal-title":"AIDS Res Ther"},{"issue":"1","key":"pmed.1004957.ref036","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1186\/s12913-021-07073-0","article-title":"Integrating diabetes, hypertension and HIV care in sub-Saharan Africa: a Delphi consensus study on international best practice","volume":"21","author":"G McCombe","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"10","key":"pmed.1004957.ref037","doi-asserted-by":"crossref","first-page":"663","DOI":"10.7196\/SAMJ.8569","article-title":"Healthy migration: a public health and development imperative for south(ern) Africa","volume":"104","author":"J Vearey","year":"2014","journal-title":"S Afr Med J"},{"issue":"12","key":"pmed.1004957.ref038","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(24)00175-9","article-title":"Interventions to ensure access to and continuity of HIV care for international migrants: an evidence synthesis","volume":"11","author":"A Kamenshchikova","year":"2024","journal-title":"Lancet HIV"},{"issue":"2","key":"pmed.1004957.ref039","article-title":"Integrated multi-month dispensing for HIV and hypertension in South Africa: a model of epidemiological impact and cost-effectiveness","volume":"28","author":"Y Jo","year":"2025","journal-title":"J Int AIDS Soc"},{"issue":"1","key":"pmed.1004957.ref040","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s43058-024-00625-5","article-title":"Understanding barriers and facilitators to integrated HIV and hypertension care in South Africa","volume":"5","author":"LCM Johnson","year":"2024","journal-title":"Implement Sci Commun"},{"issue":"9","key":"pmed.1004957.ref041","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002055","article-title":"Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011\u20132017","volume":"3","author":"M Benade","year":"2023","journal-title":"PLOS Global Public Health"},{"issue":"13","key":"pmed.1004957.ref042","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1056\/NEJMoa2509958","article-title":"Home-Based care for hypertension in rural South Africa","volume":"393","author":"MJ Siedner","year":"2025","journal-title":"N Engl J Med"}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004957","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:36:18Z","timestamp":1789148178000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004957"}},"subtitle":[],"editor":[{"given":"Andre P","family":"Kengne","sequence":"first","affiliation":[{"name":"South African Medical Research Council","place":["SOUTH AFRICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":42,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1004957","relation":{},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]}}}