A Targeted Self-Management Intervention for Reducing Stroke Risk Factors in High Risk Ugandans

项目摘要/摘要 在许多低收入和中等收入国家(LMIC)，中风是一种增加负担的神经疾病 这与高发病率和高死亡率有关。由于快速的人口增长，非洲中风的打击尤其严重 增长、寿命延长、工业化、采用有害的西方饮食以及更普遍的风险 高血压和糖尿病等因素。随着对非洲的预测指出，情况可能会恶化 卒中发病病例增加10.8%。 尽管有这些令人畏惧的预测，中风可能是一种可以预防的疾病。循证干预 如生活方式的改变和危险因素的管理可以大大减轻中风的负担。在撒哈拉以南地区 非洲(SSA)几乎没有广泛使用和有效的方法。在资源有限的情况下，理想的方法是 需要实用、低成本、可广泛扩展并为最终消费者所接受。为回应 PAR-18-835：全球大脑和神经系统疾病研究跨越寿命，拟议的项目 建立在有希望的混合方法试点工作和能力建设的基础上。在最近完成的Fogarty中 国际中心项目，学习团队制定了以课程为导向的自我管理方案，有针对性 管理(团队)旨在降低乌干达的中风风险。试点结果发现，计划保留率很高 在6个月内(87.5%)，中风风险因素(包括降低的血压)有所改善 糖尿病患者的血脂状况和改善的血糖控制。 这个为期5年、分2个阶段进行的研究项目的总体目标是测试旨在减少中风的干预措施 中风高危人群中的危险因素。该项目将评估是否以患者为中心的方法 它使用同伴教育者(有相关生活经验的患者)和社区卫生工作者共同提供 干预可能会减轻卒中负担。为了增强团队方法未来的传播潜力， 该项目将包括有效性和执行要素。在第一阶段(1-12个月)，我们将完善 由利益相关者(患者/家属、临床医生、 管理员)在本地上下文中。在第二阶段(13-60个月)，我们将进行前瞻性、随机化的 有效性-团队与常规增强治疗的实施试验(Etau)。246名参与者将是 在基线上随机接受组(N=123)或Etau(N=123)。该项目还将建立研究 在降低中风风险方面的能力，并促进建立基础设施，以促进期货的扩大。 综上所述，拟议的项目具有重大的公共卫生重要性。它将提供先决条件 乌干达和其他地区帮助减轻中风负担所需的结果数据、培训和基础设施 SSA中的国家。

PROJECT SUMMARY/ABSTRACT Stroke is a neurological condition of increasing burden in many low- and middle income countries (LMICs) that is associated with high morbidity and mortality. Africa is particularly hard-hit by stroke due to rapid population growth, expanding lifespan, industrialization, adoption of harmful western diets, and greater prevalence of risk factors such as hypertension and diabetes. The situation is likely to worsen as projections for Africa note an increase of 10.8% in incident stroke cases. In spite of these daunting projections, stroke can be a preventable disorder. Evidence-based interventions such as life-style changes and management of risk factors can greatly reduce stroke burden. In sub-Saharan Africa (SSA) there are few widely used and effective approaches. Given resource constraints, the ideal approach needs to be practical, low-cost, widely scale-able, and acceptable to the end-consumer. Written in response to PAR-18-835: Global Brain and Nervous System Disorders Research across the Lifespan, the proposed project builds upon promising mixed-methods pilot work and capacity-building. In a recently completed Fogarty International Center project, the study team developed a curriculum-guided self-management program, TargetEd MAnageMent (TEAM) intended to reduce stroke risk in Uganda. Pilot results found excellent program retention over a 6-month period (87.5 %) and reduced stroke risk factors, including decreased blood pressure, improved serum lipid profiles, and improved glucose control among individuals with diabetes. The overall goal of this 2-phase, 5-year research project is to test an intervention intended to reduce stroke risk factors in Ugandans at high risk for stroke. The project will evaluate whether a patient -centered approach that uses peer educators (patients with relevant lived experience) and community health workers to co -deliver the intervention may reduce stroke burden. To enhance future dissemination potential of the TEAM approach, the project will include both effectiveness and implementation elements. In Phase 1 (months 1-12), we will refine the TEAM intervention for content and process guided by stakeholders (patients/family, clinicians, administrators) in the local context. In Phase 2 (months 13-60) we will conduct a prospective, randomized effectiveness-implementation trial of TEAM vs. enhance treatment as usual (ETAU). 246 participants will be randomized at baseline to receive either TEAM (N= 123) or ETAU (N=123). The project will also build research capacity in stroke risk reduction and facilitate the establishment of an infrastructure to facilitate futures scale-up. Taken together, the proposed project has substantial public health importance. It will provide the prerequisite outcomes data, training, and infrastructure needed to help with reducing stroke burden in Uganda and other countries in SSA.