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

社区血压小组 - 制定干预措施以改善津巴布韦的血压控制

• 批准号: MR/Y503198/1
• 负责人: Kalpana Sabapathy
• 金额: $ 19.72万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2023
• 资助国家: 英国
• 起止时间: 2023 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FY503198%2F1
• 关键词: Community; Blood; Pressure; Groups; developing

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.

我们的目标是通过一种有效且可大规模实施的方法，使用“社区BP组”（com-BP-groups）来改善津巴布韦的血压（BP）控制。高血压是导致心血管疾病（如中风和心脏病）的主要风险因素，在津巴布韦影响超过20%的成年人。大多数高血压没有得到诊断，而且在诊断后往往没有得到充分控制，因此个人仍然处于危险之中而不自知。撒哈拉以南非洲艾滋病毒感染者社区抗逆转录病毒治疗（ART）小组在小组成员的支持下，帮助减少患者的障碍，共同重复收集药物（减少每个人的时间和经济负担），以及同伴支持长期持续治疗。在英国，家庭血压测量越来越多地用于高血压控制。利用吸取的经验教训，我们将探索由高血压患者组成的com-BP组，由“焦点”患者领导，这些患者提供低成本的经验证的家庭BP监测器，与家庭成员和邻居分享。将建议在家庭监测中符合WHO高血压标准的个人与常规诊所服务联系起来，并促进形成com-BP-group。我们假设，com-BP-groups将有助于更好地控制血压：1）使自我血压测量在家里或方便的社区地点，增加高血压的检测; 2）提供同伴支持的诊所出勤率和提高治疗覆盖率; 3）通过实现持续的定期自我监测来改善长期的最佳BP控制，改善稳定患者的长期药物治疗和群体药物收集的持续性。我们的目标是：1）检查com-BP-group是否适合和可行，以及交付所需的组件2）实施com-BP-group干预的初步版本6个月，以检查它们的可接受程度以及社区成员的吸收情况; 3）监测初步方法，以审查可行性，公平获取，交付的障碍/促成因素以及com-BP-group参与的意外后果。在第一阶段，我们将与利益相关者合作，并进行定性研究（焦点小组讨论，深入访谈，并通过“变革理论”研讨会，让社区成员和相关社区的医疗服务提供者参与进来，以了解com-BP-groups如何发挥作用）。来自第1阶段的信息将告知将在第2阶段进行测试的com-BP组的详细实施。在卫生设施的覆盖范围内，将在农村Mazowe区和奇通维萨镇开办com-BP-groups。我们将进行定性和定量研究，以借鉴办法草案。在第三阶段，我们将从用户和提供商的角度评估com-BP-groups是否合适和可接受，以及将来实施com-BP-groups的可行性。与卫生和儿童保育部及其他合作伙伴共同制作目前的研究报告将有助于确保我们的研究成果产生长期影响，并有可能转化为津巴布韦未来的实践。