Management of Hypertension Utilizing Trained Community Health Worker in Rural Municipalities of Nepal
Condition: Hypertension,Essential
MeSH terms: Hypertension; Essential Hypertension
Study type: Interventional

Summary: 
      The investigators will evaluate whether a system involving Female Community Health Volunteers
      (FCHVs) and facility-based community health workers (FB-CHWs) of Health Post (Auxiliary
      Health Workers, Auxiliary Nurse Midwives and Health Assistant) can contribute to improving
      hypertension care in rural Nepal. This study will be conducted in Rupa (active group) and
      Biruwa (comparison group) Rural Municipality of Gandaki province and enroll at least 736
      hypertensive adults (322 in Rupa Rural Municipality and 414 in Biruwa Rural Municipality) who
      are aged 25-70 years, not taking antihypertensive medication, not pregnant and not
      breastfeeding, free of prior cardiovascular disease, chronic kidney disease, and diabetes. In
      Rupa Municipality, eligible participants will be able to receive amlodipine, one of the most
      frequently used antihypertensive medications, from FB-CHWs at Health Posts and five times
      (including baseline and end of study) of lifestyle counseling by FCHVs, whereas participants
      in Biruwa Municipality will receive the usual care plus three times (including baseline and
      end of study) of lifestyle counseling by FCHVs.
    

Detailed description: 
      Despite a large body of evidence on the effectiveness of hypertension treatment in reducing
      cardiovascular morbidity and mortality, the control rate of hypertension is low in many low
      and middle-income countries. The shortage of skilled workforce diagnosing and managing
      hypertension is one of the major barriers. A promising option is to involve community health
      workers (CHWs) in hypertension care, who have shown promising results for improving maternal
      and child health. However, the evidence on whether CHWs can diagnose and treat hypertension
      under the supervision of a physician has not been systematically tested.

      Thus, this study will evaluate whether existing Facility Based-Community Health Workers
      (FB-CHWs) and Female Community Health Volunteers (FCHVs) of the Ministry of Health can safely
      and effectively diagnose hypertension and initiate/maintain protocol-based hypertension
      treatment. This study will be conducted in Rupa (active group) and the Biruwa (comparison
      group) Rural Municipality of Gandaki province. All adults aged 25-70 years of age who reside
      in the Rupa and Biruwa municipalities are eligible for the initial screening by data
      enumerators of the Nepal Development Society (NeDS). Only eligible participants who meet the
      inclusion criteria will participate in the study.

      Rupa Rural Municipality will allow the initiation of antihypertensive medication (amlodipine)
      by FB-CHW at Health Posts under the supervision of a study physician. Biruwa Rural
      Municipality will follow usual care, which is a referral to healthcare facilities currently
      providing hypertension care. FCHVs will provide lifestyle counseling and follow up the
      adherence to hypertension treatment three times in Rupa Rural Municipality and once in Biruwa
      Rural Municipality.FCHV in Rupa Rural Municipality will make three home visits (at 3, 6, and
      9 months) whereas FCHV in Biruwa Rural Municipality will make one home visit after 3 months
      of baseline. The end of the study survey will be carried out after one year by FCHV and NeDS
      data enumerators. The primary study outcome is a net change in systolic blood pressure among
      hypertensive participants 12-months after confirming hypertension in the active vs. the
      comparison group.
    

Intervention name(s): Amlodipine; Lifestyle counselling
Intervention type(s): Drug; Behavioral
Intervention description(s): The facility-based community health worker will receive protocol-driven training to initiate amlodipine for hypertensive patients. These patients will receive lifestyle counseling by Female Community Health Volunteer through home visits (5 times [including baseline and end of the study] in the active municipality and 3 times [including baseline and end of the study] in the control municipality).; Female Community Health Volunteer will provide lifestyle counseling at the participant's home
Intervention MeSH terms: Amlodipine
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Hypertension; Community Health Worker; Medication; Amlodipine; Nepal