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Completion of isoniazid–rifapentine (3HP) for tuberculosis prevention among people living with HIV: Interim analysis of a hybrid type 3 effectiveness–implementation randomized trial

Semitala, Fred C. ; Kadota, Jillian L. ; Musinguzi, Allan ; [et al.]

Public Library of Science (PLoS) ; 2021

In: PLOS Medicine Vol. 18, No. 12 ( 2021-12-16), p. e1003875-

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In: PLOS Medicine, Public Library of Science (PLoS), Vol. 18, No. 12 ( 2021-12-16), p. e1003875-

Abstract: Scaling up shorter regimens for tuberculosis (TB) prevention such as once weekly isoniazid–rifapentine (3HP) taken for 3 months is a key priority for achieving targets set forth in the World Health Organization’s (WHO) END TB Strategy. However, there are few data on 3HP patient acceptance and completion in the context of routine HIV care in sub-Saharan Africa. Methods and findings The 3HP Options Trial is a pragmatic, parallel type 3 effectiveness–implementation randomized trial comparing 3 optimized strategies for delivering 3HP—facilitated directly observed therapy (DOT), facilitated self-administered therapy (SAT), or informed choice between DOT and SAT using a shared decision-making aid—to people receiving care at a large urban HIV clinic in Kampala, Uganda. Participants and healthcare providers were not blinded to arm assignment due to the nature of the 3HP delivery strategies. We conducted an interim analysis of participants who were enrolled and exited the 3HP treatment period between July 13, 2020 and April 30, 2021. The primary outcome, which was aggregated across trial arms for this interim analysis, was the proportion who accepted and completed 3HP (≥11 of 12 doses within 16 weeks of randomization). We used Bayesian inference analysis to estimate the posterior probability that this proportion would exceed 80% under at least 1 of the 3HP delivery strategies, a coprimary hypothesis of the trial. Through April 2021, 684 participants have been enrolled, and 479 (70%) have exited the treatment period. Of these 479 participants, 309 (65%) were women, mean age was 41.9 years (standard deviation (SD): 9.2), and mean time on antiretroviral therapy (ART) was 7.8 years (SD: 4.3). In total, 445 of them (92.9%, 95% confidence interval (CI): [90.2 to 94.9]) accepted and completed 3HP treatment. There were no differences in treatment acceptance and completion by sex, age, or time on ART. Treatment was discontinued due to a documented adverse event (AE) in 8 (1.7%) patients. The probability that treatment acceptance and completion exceeds 80% under at least 1 of the three 3HP delivery strategies was greater than 99%. The main limitations are that the trial was conducted at a single site, and the interim analysis focused on aggregate outcome data to maintain blinding of investigators to arm-specific outcomes. Conclusions 3HP was widely accepted by people living with HIV (PLHIV) in Uganda, and very high levels of treatment completion were achieved in a programmatic setting. These findings show that 3HP can enable effective scale-up of tuberculosis preventive therapy (TPT) in high-burden countries, particularly when delivery strategies are tailored to target known barriers to treatment completion. Trial registration ClinicalTrials.gov NCT03934931 .

Type of Medium: Online Resource

ISSN: 1549-1676

URL: Article

DOI: 10.1371/journal.pmed.1003875

DOI: 10.1371/journal.pmed.1003875.g001

DOI: 10.1371/journal.pmed.1003875.g002

DOI: 10.1371/journal.pmed.1003875.t001

DOI: 10.1371/journal.pmed.1003875.s001

DOI: 10.1371/journal.pmed.1003875.s002

DOI: 10.1371/journal.pmed.1003875.s003

DOI: 10.1371/journal.pmed.1003875.s004

DOI: 10.1371/journal.pmed.1003875.s005

DOI: 10.1371/journal.pmed.1003875.s006

DOI: 10.1371/journal.pmed.1003875.s007

DOI: 10.1371/journal.pmed.1003875.s008

DOI: 10.1371/journal.pmed.1003875.s009

DOI: 10.1371/journal.pmed.1003875.s010

DOI: 10.1371/journal.pmed.1003875.r001

DOI: 10.1371/journal.pmed.1003875.r002

DOI: 10.1371/journal.pmed.1003875.r003

DOI: 10.1371/journal.pmed.1003875.r004

DOI: 10.1371/journal.pmed.1003875.r005

DOI: 10.1371/journal.pmed.1003875.r006

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2021

detail.hit.zdb_id: 2164823-2

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Protocol for the 3HP Options Trial: a hybrid type 3 implementation-effectiveness randomized trial of delivery strategies for short-course tuberculosis preventive therapy among people living with HIV in Uganda

Kadota, Jillian L. ; Musinguzi, Allan ; Nabunje, Juliet ; [et al.]

Springer Science and Business Media LLC ; 2020

In: Implementation Science Vol. 15, No. 1 ( 2020-12)

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In: Implementation Science, Springer Science and Business Media LLC, Vol. 15, No. 1 ( 2020-12)

Abstract: Recently, a 3-month (12-dose) regimen of weekly isoniazid and rifapentine (3HP) was recommended by the World Health Organization for the prevention of tuberculosis (TB) among people living with HIV (PLHIV) on common antiretroviral therapy regimens. The best approach to delivering 3HP to PLHIV remains uncertain. Methods We developed a three-armed randomized trial assessing optimized strategies for delivering 3HP to PLHIV. The trial will be conducted at the Mulago Immune Suppression Syndrome (i.e., HIV/AIDS) clinic in Kampala, Uganda. We plan to recruit 1656 PLHIV, randomized 1:1 to each of the three arms (552 per arm). Using a hybrid type 3 effectiveness-implementation design, this pragmatic trial aims to (1) compare the acceptance and completion of 3HP among PLHIV under three delivery strategies: directly observed therapy (DOT), self-administered therapy (SAT), and informed patient choice of either DOT or SAT (with the assistance of a decision aid); (2) to identify processes and contextual factors that influence the acceptance and completion of 3HP under each delivery strategy; and (3) to estimate the costs and compare the cost-effectiveness of three strategies for delivering 3HP. The three delivery strategies were each optimized to address key barriers to 3HP completion using a theory-informed approach. We hypothesize that high levels of treatment acceptance and completion can be achieved among PLHIV in sub-Saharan Africa and that offering PLHIV an informed choice between the optimized DOT and SAT delivery strategies will result in greater acceptance and completion of 3HP. The design and planned evaluation of the delivery strategies were guided by the use of implementation science conceptual frameworks. Discussion 3HP—one of the most promising interventions for TB prevention—will not be scaled up unless it can be delivered in a patient-centered fashion. We highlight shared decision-making as a key element of our trial design and theorize that offering PLHIV an informed choice between optimized delivery strategies will facilitate the highest levels of treatment acceptance and completion. Trial registration ClinicalTrials.gov: NCT03934931 ; Registered 2 May 2019.

Type of Medium: Online Resource

ISSN: 1748-5908

URL: Article

DOI: 10.1186/s13012-020-01025-8

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2020

detail.hit.zdb_id: 2225822-X

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Acceptance and completion of rifapentine-based TB preventive therapy (3HP) among people living with HIV (PLHIV) in Kampala, Uganda—patient and health worker perspectives

Semitala, Fred C. ; Musinguzi, Allan ; Ssemata, Jackie ; [et al.]

Springer Science and Business Media LLC ; 2021

In: Implementation Science Communications Vol. 2, No. 1 ( 2021-12)

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In: Implementation Science Communications, Springer Science and Business Media LLC, Vol. 2, No. 1 ( 2021-12)

Abstract: A 12-dose, once-weekly regimen of isoniazid and rifapentine (3HP) is effective in preventing tuberculosis (TB) among people living with HIV (PLHIV). We sought to identify potential barriers to and facilitators of acceptance and completion of 3HP treatment from the perspective of people living with HIV (PLHIV) and health workers in a routine HIV care setting in Kampala, Uganda. Methods We conducted semi-structured interviews with 25 PLHIV and 10 health workers at an HIV/AIDS clinic in Kampala, Uganda. For both groups, we explored their understanding and interpretations of TB and TB preventive therapy (TPT), and perceptions about social and contextual factors that might influence the willingness of PLHIV to initiate and complete 3HP. We analyzed the data using an inductive thematic approach and aligned the emergent themes to the Behavior Change Wheel framework to identify sources of behavior and targeted behavior change interventions. Results Facilitators of acceptance and completion of 3HP treatment among PLHIV were fear of contracting TB, awareness of being at risk of getting TB, willingness to take TPT, trust in health workers, and the perceived benefits of directly observed therapy (DOT) and self-administered therapy (SAT) 3HP delivery strategies. Barriers included inadequate understanding of TPT, fear of potential side effects, concerns about the effectiveness of 3HP, and the perceived challenges of DOT or SAT. Among health workers, perceived facilitators included knowledge that TB is a common cause of mortality for PLHIV, fear of getting TB, and trust in the health workers by PLHIV, the advantages of once-weekly 3HP dosing, and the benefits of DOT and SAT 3HP delivery strategies. Health worker-reported barriers for PLHIV included inadequate understanding of TB and benefits of TPT, TB-associated stigma, potential side effects pill burden, and challenges of DOT and SAT 3HP delivery strategies. Lack of experience in the use of digital technology to monitor patient care was identified as a health worker-specific barrier. Identified intervention functions to address the facilitators or barriers included education, persuasion, environmental restructuring, enablement, and training. Conclusions Using a formative qualitative and comprehensive theoretical approach, we identified key barriers, facilitators, and appropriate interventions, including patient education, enhancing trust, and patient-centered treatment support that could be used to optimize the delivery of 3HP to PLHIV in our setting. These interventions are likely generalizable to other clinical interventions in similar populations in sub-Saharan Africa and other TB high-burden settings.

Type of Medium: Online Resource

ISSN: 2662-2211

URL: Article

DOI: 10.1186/s43058-021-00173-2

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2021

detail.hit.zdb_id: 3038166-6

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24-hour ambulatory blood pressure monitoring and hypertension related risk among HIV-positive and HIV-negative individuals: cross sectional study findings from rural Uganda

Niwaha, Anxious J. ; Wosu, Adaeze C. ; Namugenyi, Christabellah ; [et al.]

Springer Science and Business Media LLC ; 2022

In: Journal of Human Hypertension Vol. 36, No. 2 ( 2022-02), p. 144-152

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In: Journal of Human Hypertension, Springer Science and Business Media LLC, Vol. 36, No. 2 ( 2022-02), p. 144-152

Type of Medium: Online Resource

ISSN: 0950-9240 , 1476-5527

URL: Article

DOI: 10.1038/s41371-020-00464-6

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2022

detail.hit.zdb_id: 2006792-6

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Building locally anchored implementation science capacity: the case of the adolescent HIV implementation science alliance-supported local iS alliances

Vorkoper, Susan ; Agot, Kawango ; Dow, Dorothy E. ; [et al.]

Frontiers Media SA ; 2024

In: Frontiers in Health Services Vol. 4 ( 2024-10-14)

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In: Frontiers in Health Services, Frontiers Media SA, Vol. 4 ( 2024-10-14)

Abstract: The Fogarty International Center-led Adolescent HIV Implementation Science Alliance (AHISA) supports region-/country-specific implementation science (IS) alliances that build collaborations between research, policy, and program partners that respond to local implementation challenges. AHISA supported the development of seven locally-led IS alliances: five country-specific (i.e., Kenya, South Africa, Tanzania, Uganda, and Zambia), one in Central and West Africa, and one with youth researchers. This article outlines the aims, activities, and outcomes of local alliances, demonstrating how they enhance sustainable IS activities to address local challenges. Methods We conducted a desk review of each alliance's funding applications, reports, and data from the initial findings of a larger AHISA evaluation. The review analyzes common approaches, highlights their local relevance, and summarizes initial outcomes. Results The local alliances have a common goal: to expand implementation of successful interventions to improve adolescent HIV. We identified four overarching themes across the local alliances’ activities: capacity building, priority setting, stakeholder engagement, and knowledge dissemination. Research capacity building activities include long-term mentorship between junior and senior researchers and short-term training for non-research partners. Setting priorities with members identifies local research needs and streamlines activities. Alliances incorporate substantial engagement between partners, particularly youth, who may serve as leaders and co-create activities. Dissemination shares activities and results broadly. Conclusion Local IS alliances play a key role in building sustainable IS learning and collaboration platforms, enabling improved uptake of evidence into policy and programs, increased IS research capacity, and shared approaches to addressing implementation challenges.

Type of Medium: Online Resource

ISSN: 2813-0146

URL: Article

DOI: 10.3389/frhs.2024.1439957

Language: Unknown

Publisher: Frontiers Media SA

Publication Date: 2024

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Characterization of oral swab samples for diagnosis of pulmonary tuberculosis

Wood, Rachel C. ; Andama, Alfred ; Hermansky, Gleda ; [et al.]

Public Library of Science (PLoS) ; 2021

In: PLOS ONE Vol. 16, No. 5 ( 2021-5-17), p. e0251422-

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In: PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 5 ( 2021-5-17), p. e0251422-

Abstract: Oral swab analysis (OSA) has been shown to detect Mycobacterium tuberculosis (MTB) DNA in patients with pulmonary tuberculosis (TB). In previous analyses, qPCR testing of swab samples collected from tongue dorsa was up to 93% sensitive relative to sputum GeneXpert, when 2 swabs per patient were tested. The present study modified sample collection methods to increase sample biomass and characterized the viability of bacilli present in tongue swabs. A qPCR targeting conserved bacterial ribosomal rRNA gene (rDNA) sequences was used to quantify bacterial biomass in samples. There was no detectable reduction in total bacterial rDNA signal over the course of 10 rapidly repeated tongue samplings, indicating that swabs collect only a small portion of the biomass available for testing. Copan FLOQSwabs collected ~2-fold more biomass than Puritan PurFlock swabs, the best brand used previously (p = 0.006). FLOQSwabs were therefore evaluated in patients with possible TB in Uganda. A FLOQSwab was collected from each patient upon enrollment (Day 1) and, in a subset of sputum GeneXpert Ultra-positive patients, a second swab was collected on the following day (Day 2). Swabs were tested for MTB DNA by manual IS6110-targeted qPCR. Relative to sputum GeneXpert Ultra, single-swab sensitivity was 88% (44/50) on Day 1 and 94.4% (17/18) on Day 2. Specificity was 79.2% (42/53). Among an expanded sample of Ugandan patients, 62% (87/141) had colony-forming bacilli in their tongue dorsum swab samples. These findings will help guide further development of this promising TB screening method.

Type of Medium: Online Resource

ISSN: 1932-6203

URL: Article

DOI: 10.1371/journal.pone.0251422

DOI: 10.1371/journal.pone.0251422.g001

DOI: 10.1371/journal.pone.0251422.g002

DOI: 10.1371/journal.pone.0251422.g003

DOI: 10.1371/journal.pone.0251422.t001

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DOI: 10.1371/journal.pone.0251422.t003

DOI: 10.1371/journal.pone.0251422.t004

DOI: 10.1371/journal.pone.0251422.t005

DOI: 10.1371/journal.pone.0251422.t006

DOI: 10.1371/journal.pone.0251422.s001

DOI: 10.1371/journal.pone.0251422.s002

DOI: 10.1371/journal.pone.0251422.s003

DOI: 10.1371/journal.pone.0251422.s004

DOI: 10.1371/journal.pone.0251422.r001

DOI: 10.1371/journal.pone.0251422.r002

DOI: 10.1371/journal.pone.0251422.r003

DOI: 10.1371/journal.pone.0251422.r004

DOI: 10.1371/journal.pone.0251422.r005

DOI: 10.1371/journal.pone.0251422.r006

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2021

detail.hit.zdb_id: 2267670-3

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Yield and Efficiency of Novel Intensified Tuberculosis Case-Finding Algorithms for People Living with HIV

Yoon, Christina ; Semitala, Fred C. ; Asege, Lucy ; [et al.]

American Thoracic Society ; 2019

In: American Journal of Respiratory and Critical Care Medicine Vol. 199, No. 5 ( 2019-03-01), p. 643-650

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In: American Journal of Respiratory and Critical Care Medicine, American Thoracic Society, Vol. 199, No. 5 ( 2019-03-01), p. 643-650

Type of Medium: Online Resource

ISSN: 1073-449X , 1535-4970

URL: Article

DOI: 10.1164/rccm.201803-0490OC

RVK:

XA 21200

Language: English

Publisher: American Thoracic Society

Publication Date: 2019

detail.hit.zdb_id: 1468352-0

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Uptake of community antiretroviral group delivery models for persons living with HIV in Arua district, Uganda: A parallel convergent mixed methods study

Muzeyi, Wani ; Aggrey, Semeere ; Kalibbala, Dennis ; [et al.]

Public Library of Science (PLoS) ; 2023

In: PLOS Global Public Health Vol. 3, No. 2 ( 2023-2-23), p. e0000633-

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In: PLOS Global Public Health, Public Library of Science (PLoS), Vol. 3, No. 2 ( 2023-2-23), p. e0000633-

Abstract: Community antiretroviral groups (CAGs) is one of the innovative and efficient differentiated service delivery models (DSDM) for reaching persons needing human immunodeficiency virus (HIV) treatment in the community. Since DSDM adoption in Uganda, evidence suggests better care outcomes for patients in DSDM compared to counterparts in routine health facility care. However, uptake of CAG models for eligible community groups of persons living with HIV (PLHIV) has been slow in Arua district, Uganda and stakeholders’ perceptions regarding its implementation unexplored. The objective of the study was to determine the uptake, barriers and facilitators influencing CAG model implementation in Arua district, Uganda. We conducted a parallel convergent mixed-methods study from March 2020 to December 2020 at Adumi health centre IV and Kuluva hospital in Arua district. We enrolled and extracted data for every fifth virally suppressed participant on antiretroviral therapy (ART) at the two health facilities. Data were analysed using STATA 13.0. Uptake was determined as the proportion of eligible PLHIV that were enrolled into a group. We performed logistic regression to determine factors associated with uptake. We conducted one focus group discussion per facility among healthcare workers involved in the management of PLHIV. We also conducted 7 focus group discussions among PLHIV across the two facilities. Thematic analysis was used to describe the data. A total of 399 PLHIV were eligible for CAG, 61.6% were female, and 44.9% were on dolutegravir (DTG) based regimen. Uptake was 6.8%, 95% CI (4.7–9.7) and was found to be significantly associated with being divorced or separated in a marriage (OR; 0.14, 95%CI; 0.02–0.92, P = 0.014). Members picking drugs in turns, comforting and encouraging others to take the drugs, and health workers advising them to join and stay with other group members were perceived as facilitators to uptake of community antiretroviral group delivery model. Having few and distant eligible members in the local area to form a group, lack of transport among the member to pick the drugs when it’s their turn, misunderstandings and lack of confidentiality amongst the members, and lack of partner disclosure were perceived as barriers to uptake of community antiretroviral group delivery model. Uptake of community antiretroviral group delivery model in Arua district is very low. There may be a need to support community antiretroviral group delivery models with income- generating activities, transport facilitation, closer community drug pick-up points and improved partner disclosure support mechanisms among married group members.

Type of Medium: Online Resource

ISSN: 2767-3375

URL: Article

DOI: 10.1371/journal.pgph.0000633

DOI: 10.1371/journal.pgph.0000633.g001

DOI: 10.1371/journal.pgph.0000633.t001

DOI: 10.1371/journal.pgph.0000633.t002

DOI: 10.1371/journal.pgph.0000633.t003

DOI: 10.1371/journal.pgph.0000633.s001

DOI: 10.1371/journal.pgph.0000633.s002

DOI: 10.1371/journal.pgph.0000633.r001

DOI: 10.1371/journal.pgph.0000633.r002

DOI: 10.1371/journal.pgph.0000633.r003

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2023

detail.hit.zdb_id: 3101394-6

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Uptake and perceptions of oral HIV self-testing delivered by village health teams among men in Central Uganda: A concurrent parallel mixed methods analysis

Nangendo, Joanita ; Katahoire, Anne R. ; Karamagi, Charles A. ; [et al.]

Public Library of Science (PLoS) ; 2023

In: PLOS Global Public Health Vol. 3, No. 6 ( 2023-6-14), p. e0002019-

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In: PLOS Global Public Health, Public Library of Science (PLoS), Vol. 3, No. 6 ( 2023-6-14), p. e0002019-

Abstract: The World Health Organization (WHO) recommends HIV self-testing (HIVST) to increase access to and utilization of HIV services among underserved populations. We assessed the uptake and perceptions of oral HIVST delivered by Village Health Teams (VHTs) among men in a peri-urban district in Central Uganda. We used a concurrent parallel mixed methods study design and analyzed data from 1628 men enrolled in a prospective cohort in Mpigi district, Central Uganda between October 2018 and June 2019. VHTs distributed HIVST kits and linkage-to-care information leaflets to participants in 30 study villages allowing up-to 10 days each to self-test. At baseline, we collected data on participant socio-demographics, testing history and risk behavior for HIV. During follow-up, we measured HIVST uptake (using self-reports and proof of a used kit) and conducted in-depth interviews to explore participants’ perceptions of using HIVST. We used descriptive statistics to analyze the quantitative data and a hybrid inductive, and deductive thematic analysis for the qualitative data and integrated the results at interpretation. The median age of men was 28 years, HIVST uptake was 96% (1564/1628), HIV positivity yield was 4% (63/1564) and reported disclosure of HIVST results to sexual partners and significant others was 75.6% (1183/1564). Men perceived HIVST as a quick, flexible, convenient, and more private form of testing; allowing disclosure of HIV test results to sexual partners, friends and family, and receiving social support. Others perceived it as an opportunity for knowing or re-confirming their sero-status and subsequent linkage or re-linkage to care and prevention. Utilizing VHT networks for community-based delivery of HIVST is effective in reaching men with HIV testing services. Men perceived HIVST as highly beneficial but needed more training on performing the test and the integrating post-test counseling support to optimize use of the test for diagnosing HIV.

Type of Medium: Online Resource

ISSN: 2767-3375

URL: Article

DOI: 10.1371/journal.pgph.0002019

DOI: 10.1371/journal.pgph.0002019.g001

DOI: 10.1371/journal.pgph.0002019.t001

DOI: 10.1371/journal.pgph.0002019.t002

DOI: 10.1371/journal.pgph.0002019.t003

DOI: 10.1371/journal.pgph.0002019.t004

DOI: 10.1371/journal.pgph.0002019.s001

DOI: 10.1371/journal.pgph.0002019.r001

DOI: 10.1371/journal.pgph.0002019.r002

DOI: 10.1371/journal.pgph.0002019.r003

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2023

detail.hit.zdb_id: 3101394-6

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Factors associated with blood pressure control in patients with hypertension and HIV at a large urban HIV clinic in Uganda

Musimbaggo, Douglas Joseph ; Kimera, Isaac Derick ; Namugenyi, Christabellah ; [et al.]

Springer Science and Business Media LLC ; 2022

In: Journal of Human Hypertension

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In: Journal of Human Hypertension, Springer Science and Business Media LLC

Abstract: Globally, people living with HIV on antiretroviral therapy have an increased risk of cardiovascular disease. Hypertension is the most important preventable risk factor for cardiovascular disease and is associated with increased morbidity. We conducted an exploratory survey with hypertensive persons living with HIV who received integrated HIV and hypertension care in a large clinic in Uganda between August 2019 and March 2020 to determine factors associated with blood pressure control at six months. Controlled blood pressure was defined as 〈 140/90 mmHg. Multivariable logistic regression was used to determine baseline factors associated with blood pressure control after 6 months of antihypertensive treatment. Of the 1061 participants, 644 (62.6%) were female. The mean age (SD) was 51.1 (9.4) years. Most participants were overweight ( n = 411, 38.7%) or obese ( n = 276, 25.9%), and 98 (8.9%) had diabetes mellitus. Blood pressure control improved from 14.4% at baseline to 66.1% at 6 months. Comorbid diabetes mellitus (odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.26–0.64, p 〈 0.001) and HIV status disclosure (OR = 0.73, 95% CI = 0.55–0.98, p = 0.037) were associated with the absence of controlled blood pressure at 6 months. In conclusion, comorbid diabetes mellitus and the disclosure of an individual’s HIV status to a close person were associated with poor blood pressure control among persons living with HIV who had hypertension. Therefore, subpopulations of persons living with HIV with hypertension and comorbid diabetes mellitus may require more thorough assessments and intensive antihypertensive management approaches to achieve blood pressure targets.

Type of Medium: Online Resource

ISSN: 0950-9240 , 1476-5527

URL: Article

DOI: 10.1038/s41371-022-00786-7

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2022

detail.hit.zdb_id: 2006792-6

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