Optimizing Linkage and Retention to Hypertension Care in Rural Kenya

描述（由申请人提供）：优化肯尼亚农村高血压护理的联系和保留。心血管疾病（CVD）是撒哈拉以南非洲30岁以上成年人死亡的主要原因。高血压是心血管疾病的一个主要危险因素，随着时间的推移，高血压在撒哈拉以南非洲的患病率正在上升，给该地区带来了重大的流行病学和经济负担。如果不充分控制高血压，其健康和经济负担将在未来几十年急剧增加。存在完善的、基于证据的高血压管理干预措施；然而，治疗和控制率很低。高血压管理的一个关键组成部分是促进受影响的个人持续获得有效的临床服务。美国国际开发署- -提供保健服务学术模式伙伴关系正在与肯尼亚政府合作，扩大其在肯尼亚西部农村的临床工作范围，将高血压和其他慢性病纳入其中。然而，将高血压患者与临床护理项目联系起来并留住他们是很困难的。因此，本应用程序的总体目标是利用多学科实施研究方法来解决将高血压患者与高血压管理计划联系起来并使其保持的挑战。具体来说，我们建议验证这样一个假设，即社区卫生工作者（chw）配备了量身定制的行为沟通策略和基于智能手机的电子健康记录工具，可以增加高血压患者与高血压护理计划的联系和保留，从而显着降低这些患者的血压。我们进一步假设这些干预措施将具有成本效益。目的1是利用创新和新颖的定性研究技术，确定将高血压患者与高血压护理项目联系和保留的促进因素和障碍。我们将利用这项调查得出的信息来设计一种量身定制的行为沟通策略和一种基于智能手机的工具，供chw使用，以优化高血压患者的联系和保留。目的2是通过开展一项三组随机试验，评估配备这些干预措施的保健医生在改善高血压患者联系和降低血压方面的有效性：1)常规护理（在招募个体时进行标准培训的保健医生）；2) CHWs具有额外定制的行为沟通策略；3)拥有量身定制的行为沟通策略的chw，他们还配备了与电子健康记录相连的智能手机。目的3是评估聚类随机试验中每个干预组的增量成本效益，包括血压单位降低成本和心血管疾病风险单位降低成本。这项研究将由一个具有不同和互补专业知识的多学科研究小组完成。我们的目标是增加在低收入和中等收入国家优化控制高血压和其他慢性疾病的可扩展和可持续战略方面的现有知识。

DESCRIPTION (provided by applicant): Optimizing Linkage and Retention to Hypertension Care in Rural Kenya. Cardiovascular disease (CVD) is the leading cause of death in sub-Saharan Africa among adults above age 30. The prevalence of hypertension, a major risk factor for CVD, is increasing over time in sub-Saharan Africa, exerting a significant epidemiologic and economic burden on the region. Without adequate control of hypertension, its health and economic burden will increase drastically in the decades ahead. Well established and evidence-based interventions to manage hypertension exist; however, treatment and control rates are low. A critical component of hypertension management is to facilitate sustained access of affected individuals to effective clinical services. In partnership with the Government of Kenya, the United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership (AMPATH) is expanding its clinical scope of work in rural western Kenya to include hypertension and other chronic diseases. However, linking and retaining individuals with elevated blood pressure to the clinical care program has been difficult. Thus, the overall objective of this application is to utilize a multi-disciplinary implementation research approach t address the challenge of linking and retaining hypertensive individuals to a hypertension management program. Specifically, we propose to test the hypothesis that community health workers (CHWs), equipped with a tailored behavioral communication strategy and a smartphone-based tool linked to an electronic health record, can increase linkage and retention of hypertensive individuals to a hypertension care program and thereby significantly reduce blood pressure among these patients. We further hypothesize that these interventions will be cost-effective. Aim 1 is to identify facilitators and barriers to linking and retaining individualswith high blood pressure to a hypertension care delivery program, using innovative and novel qualitative research techniques. We will use the information derived from this investigation to design a tailored behavioral communication strategy and a smartphone-based tool to be used by CHWs to optimize linkage and retention of hypertensive patients. Aim 2 is to evaluate the effectiveness of CHWs equipped with these interventions in improving linkage and reducing blood pressure among hypertensive patients, by conducting a three-arm cluster randomized trial comparing: 1) usual care (CHWs with standard training on recruitment of individuals); 2) CHWs with an additional tailored behavioral communication strategy; and 3) CHWs with a tailored behavioral communication strategy who are also equipped with smartphones linked to the electronic health record. Aim 3 is to evaluate the incremental cost-effectiveness of each intervention arm of the cluster randomized trial, presented both in terms of costs per unit decrease in blood pressure and costs per reductions in CVD risk. The research will be accomplished by a multidisciplinary team of investigators with diverse and complementary expertise. We aim to add to existing knowledge on scalable and sustainable strategies for optimizing control of hypertension and other chronic diseases in low- and middle-income countries. RELEVANCE: Optimizing Linkage and Retention to Hypertension Care in Rural Kenya. Hypertension is the leading global risk factor for mortality and the global cost of suboptimal blood pressure is estimated to be nearly $1 trillion over the next decade. This project therefore aims to address a singularly critical health and development issue for low- and middle-income countries. The results of this work will add to the emerging body of knowledge on scalable and sustainable strategies for effectively managing hypertension and related chronic diseases in low- and middle-income countries, as well as resource-poor settings in the USA and other high-income countries.