NIHR Global Health Research Group Improving Hypertension Control in Rural Sub-Saharan Africa (IHCoR-Africa) Many people live with high blood pressure in Sub-Saharan Africa (SSA), where the rate is amongst the highest in the world. In SSA, high blood pressure occurs at young ages, few people are treated, and high blood pressure causes severe complications and premature deaths. This is a serious health concern particularly in SSA where there is little knowledge of, or treatment for this condition. The causes of the high impact of high blood pressure in rural SSA are multiple including lack of clear symptoms; restricted access to healthcare; and competing demands on time which may prevent people from going to clinics and seeking care. One suggested approach to improve the management of people with high blood pressure in rural SSA is to use a community-centred approach, where care is more actively promoted and brought into the community to remove obstacles in accessing it.

Our proposed NIHR Group will develop and assess a community-based approach to improve the identification and management of high blood pressure in rural SSA (in Kilifi, Kenya and Kiang West,
the Gambia).

The research will be divided into three linked work packages that match the specified objectives. We will adopt a multidisciplinary research approach including document reviews; in-depth interviews, focus groups with patients living with high blood pressure, healthcare workers and other key stakeholders; cross-sectional studies; a co-creation design to develop the intervention; and, a cluster feasibility trial to test it.

The work is being developed in partnership by the KEMRI-Wellcome Trust Research Programme in Kenya, MRC the Gambia and The London School of Hygiene & Tropical Medicine. Within the core research team, there is a strong expertise in high blood pressure research. There is support from other key stakeholders including existing local community health organisations and the Ministries of Health in Kenya and the Gambia. Community engagement and involvement are key to this work. Existing community health worker organisations and patients have been consulted in the development of this work and will contribute throughout the research as part of interviews, focus groups and the co-creation process.

In addition to the research, we will provide a training programme in hypertension research in SSA.

Dissemination: The research team involved in this work includes staff closely linked with the local community and community health workers, collaborators from non-governmental and governmental organisations who will ensure grassroots dissemination and sustained implementation of the findings beyond the research period. We will also pursue traditional dissemination routes including publishing results in academic journals and presenting the results at international conferences. 1) To understand what is currently done (and what needs to be done) at all levels from patients to the whole healthcare system. To understand how the current healthcare system operates, and what changes need to be made, from patients upwards.
2) To improve the way community workers can decide whom to treat for high blood pressure.
3) To co-create, with patients and health workers, and test a new community-based programme for treating high blood pressure.