A Targeted Self-Management Intervention for Reducing Stroke Risk Factors in High Risk Ugandans

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PROJECT SUMMARY/ABSTRACT Stroke is a neurological condition of increasing burden in many low- and middle income countries (LMICs) that is associated with high morbidity and mortality. Africa is particularly hard-hit by stroke due to rapid population growth, expanding lifespan, industrialization, adoption of harmful western diets, and greater prevalence of risk factors such as hypertension and diabetes. The situation is likely to worsen as projections for Africa note an increase of 10.8% in incident stroke cases. In spite of these daunting projections, stroke can be a preventable disorder. Evidence-based interventions such as life-style changes and management of risk factors can greatly reduce stroke burden. In sub-Saharan Africa (SSA) there are few widely used and effective approaches. Given resource constraints, the ideal approach needs to be practical, low-cost, widely scale-able, and acceptable to the end-consumer. Written in response to PAR-18-835: Global Brain and Nervous System Disorders Research across the Lifespan, the proposed project builds upon promising mixed-methods pilot work and capacity-building. In a recently completed Fogarty International Center project, the study team developed a curriculum-guided self-management program, TargetEd MAnageMent (TEAM) intended to reduce stroke risk in Uganda. Pilot results found excellent program retention over a 6-month period (87.5 %) and reduced stroke risk factors, including decreased blood pressure, improved serum lipid profiles, and improved glucose control among individuals with diabetes. The overall goal of this 2-phase, 5-year research project is to test an intervention intended to reduce stroke risk factors in Ugandans at high risk for stroke. The project will evaluate whether a patient -centered approach that uses peer educators (patients with relevant lived experience) and community health workers to co -deliver the intervention may reduce stroke burden. To enhance future dissemination potential of the TEAM approach, the project will include both effectiveness and implementation elements. In Phase 1 (months 1-12), we will refine the TEAM intervention for content and process guided by stakeholders (patients/family, clinicians, administrators) in the local context. In Phase 2 (months 13-60) we will conduct a prospective, randomized effectiveness-implementation trial of TEAM vs. enhance treatment as usual (ETAU). 246 participants will be randomized at baseline to receive either TEAM (N= 123) or ETAU (N=123). The project will also build research capacity in stroke risk reduction and facilitate the establishment of an infrastructure to facilitate futures scale-up. Taken together, the proposed project has substantial public health importance. It will provide the prerequisite outcomes data, training, and infrastructure needed to help with reducing stroke burden in Uganda and other countries in SSA.