Implementation Strategies to Improve Hypertension Treatment in Kenya

改善肯尼亚高血压治疗的实施策略

• 批准号: 10659258
• 负责人: Matthew Hickey
• 金额: $ 20.12万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-05 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10659258
• 关键词: Address; Adherence; Adult; Africa; Africa South of the Sahara; Blood Pressure; Cardiovascular Diseases; Caring; Center for Translational Science Activities; Chronic; Chronic Care; Clinic; Clinic Visits; Clinical; Clinical Research; Data; Diagnosis; Disease; Effectiveness; Ensure; Evaluation; Evidence based intervention; Funding; Goals; Guidelines; HIV; Health; Health Personnel; Health system; Hypertension; Intervention; Interview; Kenya; Learning; Long-Term Care; Maps; Mentors; Mentorship; Methods; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Outcome; Patient Preferences; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Pilot Projects; Population; Premature Mortality; Process; Proctor framework; Provider; Public Health; Research; Research Methodology; Research Personnel; Risk Factors; Rural; Sampling; Site; Structure; Surveys; Testing; Theoretical Domains framework; Training; Treatment outcome; Uganda; United States National Institutes of Health; Well in self; acceptability and feasibility; behavior change wheel; blood pressure control; cardiovascular disorder prevention; cardiovascular disorder risk; care delivery; care systems; chronic care model; cost effective; design; experience; experimental study; hypertension control; hypertension treatment; hypertensive; implementation barriers; implementation outcomes; implementation research; implementation science; implementation strategy; improved; integrated care; medication compliance; mortality; patient engagement; patient oriented; patient-level barriers; pilot test; pragmatic trial; preference; secondary outcome; skills; theories; therapy development; treatment adherence

PROJECT SUMMARY/ABSTRACT Hypertension is the leading preventable cause of morbidity and premature mortality globally and is a major driver of the rising burden of cardiovascular disease (CVD) in sub-Saharan Africa (SSA). Hypertension can be controlled with highly efficacious, cost-effective medications; however, of the over 100 million people with hypertension in SSA, 10% or fewer have controlled blood pressure, with similar low rates of control among people with HIV. There is a strong commitment both in SSA and globally to improve treatment for hypertension and other CVD risk factors by ensuring medication supply, by leveraging the HIV chronic care model, and via primary health system strengthening. As hypertension diagnosis and medication availability improve, strategies are needed to increase patient-centeredness of chronic hypertension care models in order to engage patients in the long-term care required to reduce CVD risk and achieve optimal health outcomes. In this K23 proposal, my overall scientific objective is to assess, and test interventions that overcome, patient- level barriers to hypertension treatment adherence in a chronic HIV-hypertension care model in Kenya. This proposal is nested within the NIH-funded SEARCH SAPPHIRE trial (U01AI150510) evaluating integrated hypertension-HIV care in East Africa. In Aim 1, I will use a theory-informed mixed methods approach to evaluate barriers to hypertension treatment adherence within the SEARCH integrated hypertension-HIV care model. In Aim 2, I will conduct a discrete choice experiment to assess patient preferences for strategies to improve care delivery, using findings to develop an implementation strategy to improve patient-centered hypertension care. In Aim 3, I will conduct a pilot study to assess feasibility and acceptability of this implementation strategy. My overall training objective is to develop expertise in implementation science approaches to improve the patient- centeredness and effectiveness of integrated care models for hypertension and HIV in sub-Saharan Africa. My research aims map to my specific training objectives to: (1) develop expertise in hypertension and CVD clinical research, (2) learn mixed methods applications in implementation science, (3) learn implementation science methods for intervention development and evaluation. This K23 proposal is responsive to NHLBI Strategic Objective 6, to optimize clinical and implementation research to improve health and reduce disease. My proposed training and research aims will equip me with the necessary skills to achieve my long-term goal of becoming an independent NIH-funded investigator with expertise in implementation science methods to improve CVD and HIV outcomes. Findings generated from this proposal will inform an NIH R01 application to test a multi- component strategy for improving hypertension treatment outcomes among people with and without HIV in SSA.

项目总结/摘要 高血压是全球发病和过早死亡的主要可预防原因， 撒哈拉以南非洲（SSA）心血管疾病（CVD）负担不断增加。高血压可以 控制与高效，具有成本效益的药物;然而，超过1亿人， 在SSA中，10%或更少的高血压患者的血压得到控制， 艾滋病毒感染者。在SSA和全球范围内都有一个强有力的承诺，以改善高血压的治疗 和其他心血管疾病的风险因素，通过确保药物供应，通过利用艾滋病毒慢性护理模式，并通过 加强初级卫生系统。随着高血压诊断和药物可用性的改善， 需要增加慢性高血压护理模式的以患者为中心， 降低心血管疾病风险和实现最佳健康结果所需的长期护理。 在这个K23提案中，我的总体科学目标是评估和测试克服患者的干预措施- 肯尼亚慢性HIV高血压护理模式中高血压治疗依从性的水平障碍。这 该提案嵌套在NIH资助的SAPPHIRE试验（U 01 AI 150510）中， 东非的高血压和艾滋病护理。在目标1中，我将使用一种基于理论的混合方法来评估 高血压-艾滋病综合护理模式中高血压治疗依从性的障碍。在 目标2，我将进行离散选择实验，以评估患者对改善护理策略的偏好 交付，利用研究结果制定实施策略，以改善以患者为中心的高血压护理。在 目标三：我会进行一项试验研究，以评估这项推行策略的可行性和可接受性。 我的总体培训目标是发展实施科学方法的专业知识，以改善患者- 撒哈拉以南非洲高血压和艾滋病毒综合护理模式的中心性和有效性。我 研究目标映射到我的具体培训目标：（1）发展高血压和心血管疾病临床专业知识 研究，（2）学习混合方法在实施科学中的应用，（3）学习实施科学 干预开发和评估方法。此K23提案是对NHLBI战略的响应 目标6，优化临床和实施研究，以改善健康，减少疾病。我 建议的培训和研究目标将使我具备必要的技能，以实现我的长期目标， 成为一名独立的NIH资助的研究人员，拥有实施科学方法的专业知识， CVD和HIV结果。从该提案中产生的结果将通知NIH R 01应用程序来测试多个 在撒哈拉以南非洲，改善艾滋病毒感染者和非艾滋病毒感染者高血压治疗结果的组成部分战略。