Published in PLOS One on 2026-02-26, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Nathan Ntenkaire, Mark Kaddu Mukasa, Patience Muwanguzi, Brian Mikka, Sandra Lunkuse, Julius Mubiru, Maxwell Okwero, Beatrice Basuuta, Douglas Bulafu, Joan N. Kalyango
Source: PLOS One • DOI 10.1371/journal.pone.0327933
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Attrition among patients on chronic antihypertensive therapy is a significant problem that can lead to serious health consequences, including uncontrolled blood pressure. Several factors underlie attrition, so healthcare providers must address them to prevent treatment discontinuation and ensure optimal outcomes. Therefore, this study assessed attrition and associated factors among hypertensive patients from January 2020 and December 2022.
A sequential explanatory mixed-methods design. The quantitative study was a retrospective cohort study design using files of 1215 hypertensive patients. The qualitative study employed an explanatory descriptive design among 16 patients. A data abstraction tool and an interview guide were used for data collection. Attrition was defined as patients who were lost to follow-up. Extended Cox regression was used to determine the factors associated with time to attrition at 5% level of significance and qualitative data analysis employed a thematic analysis codebook.
The attrition proportion was 56.8% (95% confidence interval (CI) 54.0–59.7) with most patients getting lost to follow-up in 2020 (64.9%) and fewest in 2021 (54.7%). Age (hazard ratio (HR)=0.947, 95% CI 0.931–0.963), female Sex (HR = 0.734, 95% CI 0.620–0.869), residence outside Kampala (Capital City) (HR = 1.24, 95%CI 1.063–1.455), 2022 cohort entry year (HR = 1.433, 95% CI 1.156–1.777), last visit systolic blood pressure (SBP) (HR = 1.014, 95% CI 1.009–1.018), and last visit diastolic blood pressure (DBP) (HR = 0.947,95% CI 0.931–0.963) were associated with time to attrition. Loss to follow-up (LTFU) was driven by structural and contextual barriers, health system challenges, and illness perceptions and health-related limitations.
Hypertensive patient attrition proportion is high, below the Centers for Disease Control and Prevention’s 80% retention target. This calls for innovative retention strategies, and targeted support for high-risk groups like the male patients and those distant from the health facility. Patient-centered approaches addressing structural and health system barriers are essential to improving retention in hypertension care.
Introduction
Non-communicable diseases (NCDs) are responsible for the majority of deaths worldwide, low and middle-income countries (LMICs) contribute to approximately 75% of all NCD-related fatalities [1]. Globally, an estimated 1.28 billion adults (30–79 years old) have hypertension, and the majority (two-thirds) of these live in LMICs [2]. In sub-Saharan Africa (SSA), the prevalence of hypertension has risen, with estimates in 2019 reaching 48% (CI: 42–54%) among women and 34% (CI: 29–39%) among men [3]. In Uganda, hypertension is estimated to have a prevalence rate of 26.4% in general, with the highest rate of 28.5% occurring in the central region, and the lowest rate of 23.3% in the northern region. [4]. Furthermore, the prevalence rates of hypertension in urban and rural areas are estimated to be 28.9% and 25.8%, respectively [5]. Only 3.6% of hypertensive patients in Uganda have their blood pressure (BP) under control, and hypertension (HTN) and other NCDs account for 33% of all deaths with a 22% probability of dying prematurely from either cardiovascular disease, cancer, chronic respiratory diseases or diabetes [6]
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Nathan Ntenkaire, Mark Kaddu Mukasa, Patience Muwanguzi, Brian Mikka, Sandra Lunkuse, Julius Mubiru, Maxwell Okwero, Beatrice Basuuta, Douglas Bulafu, Joan N. Kalyango. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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