Community Blood Pressure Groups - developing an intervention to improve blood pressure control in Zimbabwe

我们的目标是利用“社区血压小组”（com-BP-groups），通过一种有效的、可以大规模实施的方法，发展和改善津巴布韦的血压控制。高血压是世界范围内导致中风和心脏病等心血管疾病的主要危险因素，影响着津巴布韦20%的成年人。大多数高血压是未确诊的，确诊后往往得不到充分控制，因此个人在不知情的情况下仍处于危险之中。撒哈拉以南非洲地区面向艾滋病毒感染者的社区抗逆转录病毒治疗小组有助于减少患者面临的障碍，小组成员支持共享重复药物收集（减少每个人的时间和经济负担），并为长期继续治疗提供同伴支持。在英国，家庭血压测量越来越多地用于高血压控制。利用经验教训，我们将探索由高血压患者组成的com-BP小组，由“焦点”患者领导，为他们提供低成本的经过验证的家用血压监测仪，以便与家庭成员和邻居分享。将建议在家庭监测中符合世卫组织高血压标准的个人与常规诊所服务联系起来，并促进他们组成com- bp小组。我们假设comp -BP组将有助于更好的血压控制：1)允许在家中或方便的社区地点进行自我血压测量，增加高血压的检测；2)为门诊就诊提供同伴支持，提高治疗覆盖率；3)通过持续的定期自我监测，改善长期用药的延续和稳定患者的群体药物收集，改善长期最优血压控制。我们的目标是：1)检查com- bp小组是否适合和可行，以及交付需要哪些组成部分；2)实施一个初步版本的com- bp小组干预，为期6个月，以检查它们的可接受程度以及社区成员的接受程度；3)监测初步方法，以审查可行性、获取的公平性、交付的障碍/促成因素以及com-BP-group参与的意外后果。在第一阶段，我们将与利益攸关方接触并进行定性研究（焦点小组讨论、深度访谈，以及通过一个“变革理论”讲习班，让社区成员和相关社区的卫生服务提供者参与，以获得他们对com- bp小组如何发挥作用的确切见解）。第一阶段的信息将为第二阶段测试的com- bp组的详细行为提供信息。在保健设施的集水区内，将在马祖韦县和奇通维扎镇的农村地区开展com- bp小组。我们将进行定性和定量研究，从草案方法中学习。在第三阶段，我们将从用户和提供者的角度评估com- bp组的适用性和可接受性，以及将来实现com- bp组的可行性。与卫生和儿童保育部及其他合作伙伴共同编写目前的研究报告，将有助于确保我们的研究成果产生长期影响，并有可能转化为津巴布韦未来的实践。

We aim to develop to improve blood pressure (BP) control in Zimbabwe using "Community BP Groups" (com-BP-groups) through an approach that is an effective and can be delivered at large scale. Hypertension is the leading risk factor which leads to cardiovascular outcomes such as stroke and heart disease worldwide and affects >20% adults in Zimbabwe. Most hypertension is undiagnosed, and upon diagnosis often inadequately controlled so individuals remain at risk without knowing it. Community antiretroviral treatment (ART) groups for people living with HIV in sub-Saharan Africa help to reduce barriers for patients, with support from group members for shared repeat medication collection (reducing time and financial burden on each individual), as well as peer support for long-term continuation on treatment. Home BP measurement is increasingly used in hypertension control in the UK. Leveraging lessons learned, we will explore com-BP-groups consisting of patients with hypertension, led by 'focal' patients who are provided with low-cost validated home BP monitors to share with household members and neighbours. Individuals who meet WHO criteria for hypertension on home monitoring will be advised to link to routine clinic services and facilitated to form com-BP-groups. We hypothesise that com-BP-groups will contribute towards better BP control by: 1) enabling self-BP measurement at home or convenient community locations, increasing detection of hypertension; 2) providing peer support for clinic attendance and improving treatment coverage; 3) improving long-term optimal BP control by enabling ongoing regular self-monitoring, improved continuation on long-term medication and group drug collection for stable patients. Our objectives are to 1) examine how well-suited and feasible com-BP-groups are and what components are required for delivery 2) implement a preliminary version of the com-BP-group intervention for 6 months to examine how acceptable they are and what the uptake is among community members; 3) monitor the preliminary approach to examine feasibility, equity of access, barriers/enablers of delivery and unintended consequences from com-BP-group participation. In Phase-1 we will engage stakeholders and conduct qualitative research (focus group discussions, in-depth interviews and through a "Theory of Change" workshop involving community members and those who deliver health services in the relevant communities, to gain their insights into exactly how com-BP-groups could make a difference). The information from Phase-1 will inform the detailed conduct of com-BP-groups which will be tested in Phase-2. Within the catchment area of health-facilities, com-BP-groups will be run in rural Mazowe district and Chitungwiza town. We will conduct qualitative and quantitative research to learn from the draft approach. In Phase-3, we will evaluate how suitable and acceptable com-BP-groups are from user and provider perspectives, and how feasible it will be to implement com-BP-groups in in future. Co-production of the current study with Ministry of Health and Child Care and other partners will help ensure the long-term impact and likelihood that outputs from our research will be translated into future practice in Zimbabwe.