Community Blood Pressure Groups - developing an intervention to improve blood pressure control in Zimbabwe

我们的目标是通过一种有效且可大规模交付的方法，开发使用“社区BP组”(COM-BP组)来改善津巴布韦的血压(BP)控制。高血压是导致世界范围内中风和心脏病等心血管疾病的主要危险因素，并影响津巴布韦20%的成年人。大多数高血压都没有得到诊断，一旦诊断出来，往往没有得到充分的控制，因此个体在不知情的情况下仍处于危险之中。撒哈拉以南非洲艾滋病毒感染者的社区抗逆转录病毒治疗小组有助于减少患者的障碍，小组成员支持共享重复用药(减少每个人的时间和经济负担)，以及为长期继续治疗提供同行支持。在英国，家庭血压测量越来越多地被用于控制高血压。利用所学到的经验教训，我们将探索由高血压患者组成的COM-BP小组，由“重点”患者领导，他们被提供低成本的经验证的家庭BP监测仪，与家庭成员和邻居分享。符合世卫组织家庭监测高血压标准的个人将被建议与常规诊所服务联系起来，并协助组成COM-BP-小组。我们假设，COM-BP-Group将通过以下方式为更好的血压控制做出贡献：1)在家里或方便的社区地点进行自我血压测量，增加高血压的检测；2)为诊所就诊提供同行支持，提高治疗覆盖面；3)通过持续定期自我监测，改善长期最佳血压控制，改善长期用药的连续性，并为病情稳定的患者提供集体药物收集。我们的目标是1)检查COM-BP小组有多适合和可行，以及交付需要哪些组件；2)实施COM-BP小组干预的初步版本，为期6个月，以检查社区成员对它们的接受程度和接受程度；3)监测初步方法，以检查COM-BP小组参与的可行性、公平性、交付障碍/促成因素和意外后果。在第一阶段，我们将与利益相关者接触并进行定性研究(焦点小组讨论、深入采访以及通过一个由社区成员和在相关社区提供医疗服务的人参加的“变革理论”研讨会，以获得他们对COM-BP集团如何真正产生影响的见解)。来自第一阶段的信息将告知将在第二阶段测试的COM-BP-组的详细行为。在卫生设施的集水区内，将在农村Mazowe区和Chitungwiza镇运行COM-BP集团。我们将进行定性和定量的研究，借鉴征求意见稿的做法。在第三阶段，我们将从用户和提供商的角度评估COM-BP组的适用性和可接受性，以及未来在中实施COM-BP组的可行性。与卫生和儿童保育部及其他合作伙伴共同编写目前的研究报告，将有助于确保我们的研究成果转化为津巴布韦未来实践的长期影响和可能性。

We aim to develop to improve blood pressure (BP) control in Zimbabwe using "Community BP Groups" (com-BP-groups) through an approach that is an effective and can be delivered at large scale. Hypertension is the leading risk factor which leads to cardiovascular outcomes such as stroke and heart disease worldwide and affects >20% adults in Zimbabwe. Most hypertension is undiagnosed, and upon diagnosis often inadequately controlled so individuals remain at risk without knowing it. Community antiretroviral treatment (ART) groups for people living with HIV in sub-Saharan Africa help to reduce barriers for patients, with support from group members for shared repeat medication collection (reducing time and financial burden on each individual), as well as peer support for long-term continuation on treatment. Home BP measurement is increasingly used in hypertension control in the UK. Leveraging lessons learned, we will explore com-BP-groups consisting of patients with hypertension, led by 'focal' patients who are provided with low-cost validated home BP monitors to share with household members and neighbours. Individuals who meet WHO criteria for hypertension on home monitoring will be advised to link to routine clinic services and facilitated to form com-BP-groups. We hypothesise that com-BP-groups will contribute towards better BP control by: 1) enabling self-BP measurement at home or convenient community locations, increasing detection of hypertension; 2) providing peer support for clinic attendance and improving treatment coverage; 3) improving long-term optimal BP control by enabling ongoing regular self-monitoring, improved continuation on long-term medication and group drug collection for stable patients. Our objectives are to 1) examine how well-suited and feasible com-BP-groups are and what components are required for delivery 2) implement a preliminary version of the com-BP-group intervention for 6 months to examine how acceptable they are and what the uptake is among community members; 3) monitor the preliminary approach to examine feasibility, equity of access, barriers/enablers of delivery and unintended consequences from com-BP-group participation. In Phase-1 we will engage stakeholders and conduct qualitative research (focus group discussions, in-depth interviews and through a "Theory of Change" workshop involving community members and those who deliver health services in the relevant communities, to gain their insights into exactly how com-BP-groups could make a difference). The information from Phase-1 will inform the detailed conduct of com-BP-groups which will be tested in Phase-2. Within the catchment area of health-facilities, com-BP-groups will be run in rural Mazowe district and Chitungwiza town. We will conduct qualitative and quantitative research to learn from the draft approach. In Phase-3, we will evaluate how suitable and acceptable com-BP-groups are from user and provider perspectives, and how feasible it will be to implement com-BP-groups in in future. Co-production of the current study with Ministry of Health and Child Care and other partners will help ensure the long-term impact and likelihood that outputs from our research will be translated into future practice in Zimbabwe.