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: 10688172
• 负责人: THOMAS A GAZIANO
• 金额: $ 55.4万
• 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/10688172
• 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; Consolidated Framework for Implementation Research; Country; Data; Development; Discipline of Nursing; Disease; Effectiveness; Employment; Ensure; Evidence based practice; Failure; Funding; Goals; Health; Health Personnel; Health Priorities; Health Professional; Health system; High Prevalence; Home; Home Blood Pressure Monitoring; Hour; Hypertension; Individual; Infrastructure; Intervention; Interview; Investments; Knowledge; Literature; Low income; Measures; Methods; Modeling; Morbidity - disease rate; Nurses; Patients; Penetration; Persons; Population; Primary Care; Proctor framework; Public Health; Public Sector; Quality of life; Quality-Adjusted Life Years; Randomized; Reduce health disparities; Reproducibility; Research Methodology; Resource-limited setting; Resources; Risk Factors; Rural; Self Efficacy; Site; South Africa; South African; Stroke; System; Training; Translating; Translations; Vulnerable Populations; Work; acceptability and feasibility; blood pressure control; blood pressure elevation; blood pressure reduction; care systems; clinical care; cost; cost effective; cost effective intervention; cost effectiveness; disability-adjusted life years; disorder control; effective therapy; effectiveness evaluation; global health; health disparity; hypertension control; hypertension treatment; hypertensive heart disease; implementation evaluation; implementation framework; implementation intervention; implementation outcomes; implementation science; improved; innovation; low and middle-income countries; male; monitoring device; mortality; multidisciplinary; premature; programs; response; rural South Africa; 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. !

抽象的 未控制的高血压是中风和高血压性心脏病的主要危险因素，这些疾病是中风和高血压性心脏病的主要危险因素。 南非非传染性疾病死亡以及全球残疾调整生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，高血压控制功效文献之间存在巨大的知识实施差距 以及卫生系统提供高血压护理的有效性。这在资源方面尤其如此 有限的环境，有限的公共卫生基础设施将需要创新的、可扩展的和成本低廉的 有效的干预措施。在南非，25% 的人口 15 岁以上患有高血压，但 只有 33% 的高血压患者正在接受治疗。在夸祖鲁-纳塔尔省农村地区，我们最近发现 16% 18岁以上的成年人患有高血压，只有不到25%的人得到控制。 该项目的科学目标是为实施干预措施提供最佳实践 促进撒哈拉以南非洲农村地区的高血压护理。我们开展了混合方法的形成工作 确定参与高血压护理的重大结构性障碍。对患者进行定性访谈 医疗保健专业人员还透露，患者缺乏自我效能、结构性障碍和护理 培训不足是卫生系统的额外障碍。最后，我们回顾了最佳实践 高血压护理并与当地利益相关者合作，提出了与农村地区相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。 我们将对两级干预方案进行实施评估：1） 通过阶梯楔形整群随机化，加强临床层面的干预，以及 2) 单独 随机家庭血压监测系统可促进自我效能。我们将评估 使用实施研究综合框架和监考人员进行实施 实施成果框架，重点关注可接受性和保真度（目标 1）、有效性（目标 2) 以及成本效益和可持续性（目标 3）。为此，我们将利用一个多学科团队 专家以及外部资助的高血压筛查和转诊计划，对象为 30,000 人 2018-2019 年流域面积。 该提案响应 PAR-18-007 中规定的多个优先事项，包括 1) 实施 临床环境中的循证实践，2) 与现有护理系统的合作，3) 纵向 观察以评估可持续性，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，我们已准备好推进实施 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。 ！