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

项目总结/摘要 中风是一种神经系统疾病，在许多低收入和中等收入国家（LMIC）中负担增加 与高发病率和死亡率相关。由于人口增长迅速， 增长，寿命延长，工业化，采用有害的西方饮食，以及风险的普遍性 高血压和糖尿病等因素。由于对非洲的预测指出， 中风发病率上升10.8%。 尽管有这些令人生畏的预测，中风可以是一种可预防的疾病。循证干预措施 如生活方式的改变和危险因素的管理可以大大减少中风的负担。在撒哈拉以南 在非洲（撒哈拉以南非洲），很少有广泛使用和有效的办法。在资源有限的情况下， 需要是实用的、低成本的、可广泛扩展的，并且是终端消费者可接受的。为了回应 PAR-18-835：全球脑和神经系统疾病研究跨越生命周期，拟议项目 以有希望的混合方法试点工作和能力建设为基础。在最近完成的福格蒂 国际中心项目，研究小组开发了一个由咨询指导的自我管理计划，TargetEd MAnageMent（TEAM）旨在降低乌干达的中风风险。试点结果显示，项目保留率极佳 在6个月的时间内（87.5%）和减少中风的危险因素，包括降低血压，改善 血脂谱，并改善糖尿病患者的血糖控制。 这个2期5年研究项目的总体目标是测试一种旨在减少中风的干预措施 中风高危乌干达人的危险因素。该项目将评估以病人为中心的方法是否 利用同伴教育者（有相关生活经验的患者）和社区卫生工作者共同提供 干预可以减少中风负担。为了加强贸易效率评估办法今后的传播潜力， 该项目将包括实效和执行两个要素。在第1阶段（1-12个月），我们将完善 由利益相关者（患者/家属，临床医生， 管理员）在本地环境中。在第2阶段（13-60个月），我们将进行一项前瞻性、随机 TEAM与常规强化治疗（ETAU）有效性实施试验。246人参加 在基线时随机接受TEAM（N= 123）或ETAU（N=123）。该项目还将建立研究 提高降低中风风险的能力，并促进建立基础设施，以促进未来的规模扩大。 总的来说，拟议的项目对公众健康具有重大意义。它将提供一个先决条件， 结果数据，培训和基础设施需要帮助减少乌干达和其他国家的中风负担， 在SSA的国家。

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.