Abstract 13217: Optimizing Longitudinal Retention in Care Among Patients With Hypertension in Primary Healthcare Settings: Findings From the Hypertension Treatment in Nigeria Program

Introduction: Previous hypertension research has evaluated retention using cross-sectional study designs. However, longitudinal analyses are likely more useful to identify areas for improving retention. Objective: To describe longitudinal retention patterns among patients with hypertension in primary care in 6 Federal Capital Territory council areas in Nigeria. Methods: The Hypertension Treatment in Nigeria Program implemented a multi-level intervention package in 60 centers in Nigeria. Baseline and follow-up data were collected from January 2020 to December 2021. Healthcare workers scheduled patients for a follow-up appointment at each visit, for which one month was recommended. Retention was measured by the patient presenting to the clinic for a follow-up visit within 7 days of the scheduled appointment. Results: 14,346 patients (68.7% female, mean [SD] age = 49.1 [12.6] years) were included with 61,320 documented visits, among which 14,975 were registration visits and 46,345 were follow-up visits. 9,490 (66.2%) patients had ≥1 follow-up visit. Fig 1 demonstrates longitudinal patterns for 37-day retention by council area, in which Kuje has the highest follow-up rate (55.6%) while variability was seen across areas. The median (IQR) time to the scheduled appointment was 30 days (28, 31), and observed time to follow-up visit was 32 days (29, 42). 40,759 (66.5%) appointments were scheduled ≤ 30 days, 58,773 (95.8%) appointments were scheduled ≤ 37 days, and 282 appointments (0.5%) were scheduled ≥ 60 days after the previous visit. Among documented follow-up visits, 16,524 (35.7%) occurred within 30 days of the prior visit, 32,145 (69.4%) occurred within 37 days, and 31,344 (67.6%) were within 7 days of the scheduled appointment. Conclusions: Retention in hypertension is widely variable within individuals, over time, and across council areas. Longitudinal retention analyses provide robust assessments to develop tailored strategies to improve retention.