Partnerships and organizational capacity drive sustainability of integrated hypertension–HIV care in primary health care in Uganda

BACKGROUND: The co-occurrence of HIV and non-communicable diseases (NCDs), particularly hypertension, is a growing global health issue. As people living with HIV (PLHIV) live longer due to antiretroviral therapy (ART), they become more susceptible to NCDs like hypertension due to chronic inflammation, long-term drug side effects, and metabolic factors that compound their risk. The integrated HIV/HTN project implemented a feasible and cost-effective multi-component intervention in several public health facilities in Uganda. In this study, we sought to evaluate the program sustainability of the intervention by the public health delivery system. METHODS: A mixed-methods cross-sectional study was conducted across 26 public health facilities in 13 intervention districts of southwestern Uganda. Quantitative data were collected using the Program Sustainability Assessment Tool (PSAT) from District Health Officers (N = 15), HIV focal persons (N = 10), and Facility/Clinic in-charges (N = 25). Qualitative data were gathered through in-depth interviews with healthcare managers and analyzed using Stata and Dedoose software. RESULTS: The PSAT Partnerships domain scored high (5.68), reflecting strong stakeholder engagement, communication, and leadership involvement. The Organizational Capacity domain also performed well (5.66), with strong integration of hypertension screening and data management, resource management and staff training rated at 4.24 and 4.9 respectively. Integration of HTN into HIV Care Evaluation scored (5.54), excelling in public communication but needing improvement in reporting and evaluation capacity. The Communications domain (5.51) showed moderate effectiveness, with room to enhance public engagement and feedback strategies. Environmental Support was the weakest domain (4.73), highlighting the need for better resource mobilization and training adequacy. CONCLUSION: The sustainability of a multi-component care model was strongly influenced by strong partnerships and leadership. To ensure long-term success, environmental support, resource management, and sustainability planning is essential. Addressing these gaps will strengthen ongoing integration efforts in resource-limited settings. REGISTRY: ClinicalTrials.gov, TRN: NCT04624061, Registration date: 04 November 2022.