Improving control of Hypertension in a high HIV prevalence setting (CoHHP): A cluster-randomized feasibility trial in rural Botswana

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Hypertension (high blood pressure) is the leading cause of the 18 million deaths due to strokes and heart attacks worldwide each year. Despite this and the availability of medications to treat hypertension, many individuals with hypertension are either not aware of their condition or are not sufficiently treated. This problem of uncontrolled hypertension particularly affects individuals in developing regions, including in sub-Saharan Africa where the proportion of adults with hypertension ranges from 19%-40%, and is rising. Studies in developing countries in Asia and South America have identified approaches to reduce blood pressure that can be used in low-resource settings. That said, these approaches are yet to be tested in different settings particularly in sub-Saharan Africa where shortages in skilled healthcare workers is more severe and healthcare resources are needed to address the high burden of other conditions such as HIV, TB and Malaria. As such, we are developing a multifaceted intervention (approach) to improve diagnosis and management of hypertension for African adults in rural and peri-urban areas, where resources are more limited than in urban areas. The proposed 2-year project will assist in further development of this intervention by seeking detailed inputs from hypertension patients and their providers in order to understand challenges faced in seeking/providing care, and b) assessing whether phone-based support for patients would be acceptable and effective in improving patient attendance of clinic visits. The proposed project will also inform planning for a future trial to be conducted in Botswana that will rigorously evaluate this intervention. Identifying an approach that that is possible to implement in low-resource settings, and works in reducing blood pressure has the potential to save lives in developing countries.