Implementation Strategies to Improve Hypertension Treatment in Kenya

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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.