Improving control of Hypertension in a high HIV prevalence setting (CoHHP): A cluster-randomized feasibility trial in rural Botswana

高血压(高血压)是全世界每年因中风和心脏病发作而死亡的1800万人的主要原因。尽管有治疗高血压的药物，但许多高血压患者要么没有意识到自己的病情，要么没有得到充分的治疗。这一失控的高血压问题特别影响发展中区域的个人，包括撒哈拉以南非洲，那里的成年人高血压比例从19%-40%不等，而且还在上升。在亚洲和南美洲发展中国家的研究已经确定了可以在低资源环境下使用的降低血压的方法。话虽如此，这些方法尚未在不同的环境中进行测试，特别是在撒哈拉以南非洲，那里熟练的医护人员短缺更为严重，需要医疗资源来应对艾滋病毒、结核病和疟疾等其他疾病的沉重负担。因此，我们正在开发一种多方面的干预措施(方法)，以改善农村和城市周边地区非洲成年人高血压的诊断和管理，这些地区的资源比城市地区更有限。拟议的为期两年的项目将通过寻求高血压患者及其提供者的详细信息，以了解寻求/提供护理所面临的挑战，以及b)评估对患者的电话支持在改善患者就诊情况方面是否可以接受和有效，从而帮助这一干预措施的进一步发展。拟议的项目还将为在博茨瓦纳进行的未来试验的规划提供信息，该试验将严格评估这一干预措施。确定一种可能在低资源环境下实施并在降低血压方面有效的方法，有可能拯救发展中国家的生命。

Hypertension (high blood pressure) is the leading cause of the 18 million deaths due to strokes and heart attacks worldwide each year. Despite this and the availability of medications to treat hypertension, many individuals with hypertension are either not aware of their condition or are not sufficiently treated. This problem of uncontrolled hypertension particularly affects individuals in developing regions, including in sub-Saharan Africa where the proportion of adults with hypertension ranges from 19%-40%, and is rising. Studies in developing countries in Asia and South America have identified approaches to reduce blood pressure that can be used in low-resource settings. That said, these approaches are yet to be tested in different settings particularly in sub-Saharan Africa where shortages in skilled healthcare workers is more severe and healthcare resources are needed to address the high burden of other conditions such as HIV, TB and Malaria. As such, we are developing a multifaceted intervention (approach) to improve diagnosis and management of hypertension for African adults in rural and peri-urban areas, where resources are more limited than in urban areas. The proposed 2-year project will assist in further development of this intervention by seeking detailed inputs from hypertension patients and their providers in order to understand challenges faced in seeking/providing care, and b) assessing whether phone-based support for patients would be acceptable and effective in improving patient attendance of clinic visits. The proposed project will also inform planning for a future trial to be conducted in Botswana that will rigorously evaluate this intervention. Identifying an approach that that is possible to implement in low-resource settings, and works in reducing blood pressure has the potential to save lives in developing countries.