Implementation of a Combination Intervention for Sustainable Blood Pressure Control in Rural KwaZulu-Natal, South Africa (IMPACT-BP)

在南非夸祖鲁-纳塔尔省农村地区实施可持续血压控制联合干预措施 (IMPACT-BP)

• 批准号: 9884873
• 负责人: THOMAS A GAZIANO
• 金额: $ 60.52万
• 依托单位: KWAZULU-NATAL RESEARCH INSTITUTE TB-HIV
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-04 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9884873
• 关键词: 18 year old; Achievement; Adopted; Adult; Africa South of the Sahara; Age; Blood Pressure; Blood Pressure Monitors; Caring; Catchment Area; Cessation of life; Chronic Care; Clinic; Clinical; Clinical Trials; Cluster randomized trial; Communities; Country; Data; Development; Discipline of Nursing; Effectiveness; Employment; Ensure; Evaluation; Evidence based practice; Failure; Funding; Goals; Health; Health Personnel; Health Priorities; Health Professional; Health system; High Prevalence; Home Blood Pressure Monitoring; Home environment; Hour; Hypertension; Individual; Infrastructure; Intervention; Interview; Knowledge; Literature; Low income; Measures; Methods; Modeling; Morbidity - disease rate; Nurses; Outcome; Patients; Penetration; Population; Primary Health Care; Public Health; Public Sector; Quality of life; Quality-Adjusted Life Years; Randomized; Reading; Reproducibility; Research Methodology; Resources; Risk Factors; Rural; Self Efficacy; Site; South Africa; South African; Stroke; Structure; System; Training; Translating; Translations; Vulnerable Populations; Work; base; blood pressure reduction; blood pressure regulation; care systems; clinical care; cost; cost effective; cost effectiveness; disability-adjusted life years; disorder control; effective intervention; effective therapy; global health; health disparity; hypertension control; hypertension treatment; hypertensive heart disease; implementation research; implementation science; improved; innovation; intervention cost; low and middle-income countries; male; monitoring device; mortality; multidisciplinary; premature; programs; response; rural South Africa; rural area; screening; sex; treatment as usual; years of life lost

ABSTRACT Uncontrolled hypertension is the primary risk factor for stroke and hypertensive heart disease, which are the leading causes of NCD deaths in South Africa, and of disability adjusted-life years lost globally. Clinical trials have demonstrated sizeable reductions in morbidity and mortality with modest reductions in blood pressure. Yet, there is a large knowledge-implementation gap between efficacy literature on hypertension control and effectiveness of health systems to provide hypertension care. This is particularly true in resource- limited settings, where the constrained public health infrastructure will require innovative scalable and cost- effective interventions. In South Africa, 25% of the population over 15 years have elevated blood pressure, yet only 33% of those with hypertension are on treatment. In rural KwaZulu-Natal, we recently found that 16% of adults > 18 years old have hypertension, and fewer than 25% of them are controlled. The scientific goals of this project are to inform best practices for implementation of interventions to promote hypertension care in rural sub-Saharan Africa. We have undertaken mixed-methods formative work to identify significant structural barriers to engagement in hypertension care. Qualitative interviews with patients and healthcare professionals also revealed that lack of patient self-efficacy, structural barriers, and nursing training deficiencies were additional health systems barriers. Finally, we reviewed best practices for hypertension care and engaged local stakeholders to propose a package of interventions relevant to the rural South African setting, and potentially applicable to other low-medium resource settings. We will conduct an implementation evaluation of a two-level intervention package: 1) an enhanced clinic-level intervention, through stepped-wedge cluster randomization, and 2) an individually randomized home blood pressure monitoring system to promote self-efficacy. We will evaluate the implementation using the Consolidated Framework for Implementation Research and the Proctor Implementation outcomes framework, with a focus on Acceptability & Fidelity (Aim 1), Effectiveness (Aim 2) and Cost-effectiveness and Sustainability (Aim 3). To do so, we will leverage a multidisciplinary team of experts, and an externally-funded hypertension screening and referral program for 30,000 individuals in the catchment area during 2018-2019. This proposal is responsive to multiple priorities stated in PAR-18-007, including 1) implementation of evidence-based practices within clinical settings, 2) partnership with existing care systems, 3) longitudinal observation to assess sustainability, and 4) focus on reduction of health disparities. Perhaps most importantly, due to our partnership with the Department of Health, we are well-poised to advance the implementation science to elucidate best practices for hypertension care in resource-limited settings, with global implications. !

摘要 不受控制的高血压是中风和高血压性心脏病的主要危险因素， 这是南非非传染性疾病死亡的主要原因，也是全球残疾调整寿命年损失的主要原因。临床试验 已证明发病率和死亡率大幅降低，血压略有降低。 然而，在高血压控制的有效性文献之间存在着很大的知识-实施差距， 以及卫生系统提供高血压护理的有效性。在资源方面尤其如此- 有限的设置，其中有限的公共卫生基础设施将需要创新的可扩展性和成本- 有效干预。在南非，15岁以上的人口中有25%患有高血压， 只有33%的高血压患者在接受治疗。在夸祖鲁-纳塔尔农村，我们最近发现， > 18岁的成年人患有高血压，其中不到25%得到控制。 该项目的科学目标是为实施干预措施的最佳实践提供信息， 促进撒哈拉以南非洲农村地区的高血压护理。我们进行了混合方法的形成工作， 确定参与高血压护理的重要结构性障碍。与患者的定性访谈 和医疗保健专业人员还透露，缺乏病人的自我效能感，结构性障碍，和护理 培训不足也是卫生系统面临的障碍。最后，我们回顾了 高血压护理，并与当地利益攸关方合作，提出了与农村有关的一揽子干预措施， 南非环境，并可能适用于其他中低资源环境。 我们会就两个层面的干预措施进行评估： 加强临床水平的干预，通过逐步楔形分组随机化，和2）一个单独的 随机家庭血压监测系统，以促进自我效能。我们将评估 执行情况研究综合框架和普罗克特 执行成果框架，重点是可接受性和忠实性（目标1）、有效性（目标2）、 2)成本效益和可持续性（目标3）。为此，我们将利用多学科团队， 专家，以及一个由外部资助的高血压筛查和转诊计划， 在2018-2019年期间的集水区。 本提案响应PAR-18-007中所述的多个优先事项，包括：1）实施 临床环境中的循证实践，2）与现有护理系统的伙伴关系，3）纵向 观察以评估可持续性，以及4）注重减少健康差距。也许最重要的是， 由于我们与卫生部的合作，我们已做好充分准备推进实施 科学阐明资源有限环境下高血压护理的最佳实践，具有全球影响。 !