Transforming Hypertension Management in Nigeria

工程 摘要 高架 和 基于 非常 血压(BP)是全球心血管疾病发病率的主要可修改危险因素 死亡率。在撒哈拉以南非洲人口最多的国家尼日利亚，高血压的患病率 在血压阈值&gt；140/90毫米汞柱上，成年人(&gt；40岁)估计为45%。尽管如此，1 高负担、高血压知晓率(14-30%)、治疗(20%)和控制率(9%)在 S 尼日利亚。2 2018年对119项试验(n=55641名参与者)进行的系统审查，评估执行战略 为了改善血压控制，展示了与非医生卫生工作者进行多层次团队护理 滴定降血压药物是降低收缩压(-7.1 mm Hg[95%])的最有效方法 CI：-8.9，-5.2]，10项试验)。3以患者为中心的降低收缩压最有效的干预措施是健康 教练(-3.9毫米汞柱[95%可信区间：-5.4，-2.3]，38次试验)和家庭血压监测(-2.7毫米汞[95%可信区间：-3.6，-1.7]， 26次试验)。重要的是，在这项系统性综述中，有20%的研究来自中低收入人群。 没有一个人来自撒哈拉以南非洲。 将这些发现转化为常规的临床实践需要系统来跟踪患者、表现 审查、算法、医生将控制权让给非医生，以及非医生将控制权让给和让给 支持患者，很像整个撒哈拉以南非洲地区艾滋病毒护理的结构。我们的试点数据(n=60) 来自阿布贾的尼日利亚已经证明了在1个月时降低收缩压的可行性和短期疗效 社区卫生工作者主导的护理(-10.5毫米汞柱[95%可信区间：-15.4，-5.5])和家庭血压监测(-7.3 毫米汞柱[95%CI：-11.7，-2.8])。 在这项提案中，我们将利用实施科学方法，包括REACH有效性 采用实施维护(RE-AIM)框架以适应、实施和评估证据- 基于多层次的干预措施，包括：(1)改编自Kaiser的系统级高血压计划 北加州联邦首都地区公共初级卫生保健设施的永久模式 [阿布贾]，尼日利亚，和(2)患者层面的健康指导，在高危人群样本中进行家庭血压监测 患有失控高血压的患者。我们会研究这些改编措施的成效和实施情况。 通过中断的时间序列设计对高血压治疗和控制率以及 以患者为中心的结果。我们 AS 还将使用RE-AIM框架评估执行成果， 以及系统和患者层面的可接受性和成本。这项建议直接解决了NHLBI战略愿景的关键挑战#11：“多学科， 需要多国伙伴关系来制定有效和可持续的防治慢性疾病的战略。 发展中国家的HLBS疾病，这考虑到HLBS的高度可变的当地流行病学 疾病、减少疾病负担的新方法的必要性以及实施的挑战。“4

PROJECT ABSTRACT Elevated and based very blood pressure (BP) is a leading modifiable risk factor f or global cardiovascular disease morbidity mortality. In Nigeria, the most populou country in sub-Saharan Africa, the prevalence of hypertension on a BP threshold >140/90 mmHg in adults (>40 years) has been estimated to be 45%. 1 Despite this high burden, hypertension awareness (14-30%), treatment (<20%), and control (9%) rates are very low in s Nigeria. 2 A 2018 systematic review of 119 trials (n=55,641 participants) evaluating implementation strategies for improving BP control demonstrated that multi-level team-based care with non-physician health worker titration of BP lowering medicines was the most effective approach for lowering systolic BP (-7.1 mmHg [95% CI: -8.9, -5.2], 10 trials).3 The most effective patient-centered interventions for lowering systolic BP were health coaching (-3.9 mmHg [95% CI: -5.4, -2.3], 38 trials) and home BP monitoring (-2.7 mmHg [95% CI: -3.6, -1.7], 26 trials). Importantly, <20% of the studies in this systematic review were from low- and middle-income countries, and none were from sub-Saharan Africa. Translating these findings into routine clinical practice requires systems to track patients, performance review, algorithms, physicians to cede control to non-physicians, and non-physicians to cede control to and to support patients, much like how HIV care is structured throughout sub-Saharan Africa. Our pilot data (n=60) from Abuja, Nigeria already demonstrate feasibility and short-term efficacy in lowering systolic BP at 1 month with community health worker-led care (-10.5 mmHg [95% CI: -15.4, -5.5]) and home BP monitoring (-7.3 mmHg [95% CI: -11.7, -2.8]) compared with usual care. In this proposal, we will utilize implementation science methodologies including the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to adapt, implement, and evaluate an evidence- based, multi-level intervention that includes: (1) system-level hypertension program adapted from Kaiser Permanente Northern California's model in public, primary health care facilities in Federal Capital Territory [Abuja], Nigeria, and (2) patient-level health coaching with home BP monitoring in a sample of high-risk patients with uncontrolled hypertension. We will study the effectiveness and implementation of these adapted interventions through an interrupted time series design on hypertension treatment and control rates, as well as patient-centered outcomes. We as will also evaluate the implementation outcomes using the RE-AIM framework, well as acceptability and cost, at system and patient levels for both interventions.This proposal directly addresses critical challenge #11 of the NHLBI's Strategic Vision: “Multidisciplinary, multinational partnerships are needed to develop effective and sustainable strategies for combating chronic HLBS disorders in developing nations, which take into account the highly variable local epidemiology of HLBS disorders, the need for novel approaches to reducing disease burden, and the challenges of implementation.”4