Acceptability of fixed-dose combination treatments for hypertension in Kenya: a qualitative study using the Theoretical Framework of Acceptability

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Abstract Background Fixed-dose combinations (FDCs) – 2-3 anti-hypertensive medications in a single pill - have the potential to improve hypertension treatment and outcomes. Yet, they are not widely implemented. Factors undermining implementation remain unknown, particularly in sub– Saharan Africa, where hypertension is a major cause of disease burden and is poorly treated. Methods We used in-depth semi-structured interviews to explore the acceptability of FDCs among patients, caregivers, and healthcare workers. We interviewed a total of 58 participants across four purposively selected health facilities in one county in Kenya. Data were analyzed using abductive thematic analysis approach, and emergent themes categorized according to the Theoretical Framework of Acceptability. Results Overall, FDCs are potentially acceptable to all participant groups. Acceptability is supported by a perception of FDCs as a means of reducing treatment burden (for patients and healthcare workers) and improving treatment adherence, and patients’ deferral to and trust in health workers. Acceptability among health workers may be undermined by variable levels of FDC coherence, concerns among health workers about FDCs as an “inflexible” treatment that does not allow dose titration or identifying causes of side effects, and concerns about consistent availability and affordability of FDCs in Kenya. Conclusion FDCs are a potentially acceptable treatment approach for hypertension in Kenya. Efforts to improve acceptability and thus implementation of FDCs in Kenya should consider improving understanding of treatment and strengthening the capacity of all health worker cadres to appropriately prescribe, inform about, and support adherence to FDCs. These efforts must align with work to address upstream health system factors such as poor availability and affordability.

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