Burden and Challenges of Managing Hypertension in People Living with Human Immunodeficiency Virus (HIV) Infection in Sub-Saharan Africa: A Mixed Systematic Review and Meta-Analysis.

Objectives: Poor hypertension prevention among people living with HIV (PLHIV) in sub-Saharan Africa may undermine progress in HIV prevention achieved within this population. This review synthesizes data on the prevalence, diagnosis, treatment, control, and challenges related to hypertension prevention among PLHIV in SSA. Methods: A mixed-method systematic review with meta-analysis was conducted from January to December 2024. Data analysis was performed using random-effects modeling stratified by age and sex, along with thematic analysis. The JBI critical appraisal tool was used to assess study quality. Results: A total of 31 studies, including 32286 PLHIV (±37 years old), were included. Hypertension affected 25% [95% CI, 21%-28%] of PLHIV, yet only 34% [95% CI, 11%-64%] of cases received treatment, and 19% [95% CI, 3%-34%] had controlled blood pressure, despite BP measurement in 95% [95% CI, 89%-100%] of them. Conclusion: Hypertension prevention challenges stem from patient-related factors, healthcare providers, and health system gaps. Despite the high prevalence of hypertension among PLHIV, treatment initiation and blood pressure control rates remain low. Strengthening the integration of HIV and hypertension care services is urgently needed.