Optimizing Linkage and Retention to Hypertension Care in Rural Kenya

Study Overview
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Brief Summary
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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 to address the challenge of linking and retaining hypertensive individuals to a hypertension management program. 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.

Detailed Description
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Hypertension awareness, treatment, and control rates are low in most regions of the world. 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 Academic Model Providing Access to Healthcare (AMPATH) Partnership 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. To address this challenge, we propose to develop and evaluate innovative community-based strategies and initiatives supported by mobile technology. The objective of this application is to utilize a multi-disciplinary implementation research approach to address the challenge of linking and retaining hypertensive individuals to a hypertension management program. The central hypothesis is: 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. This research will generate innovative and productive solutions to the expanding global problem of hypertension, and will add to existing knowledge on scalable and sustainable strategies for effectively managing hypertension and other chronic diseases in low- and middle-income countries.

Official Title
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Optimizing Linkage and Retention to Hypertension Care in Rural Kenya

Conditions
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Hypertension, High Blood Pressure

Intervention / Treatment
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* Behavioral: behavioral communication strategy
* Behavioral: Behavioral communication strategy, plus smartphone-based tool


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years old and older elevated BP (SBP > 140 or DBP >90) Exclusion Criteria: acutely ill and require immediate medical attention at the time of home-based testing individuals who do not provide informed consent during home-based testing

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual Care<br>Usual Care: Community Health Workers (CHW) with standard training on recruitment of individuals. | |
| Experimental: behavioral communication strategy<br>Community Health Workers with an additional tailored behavioral communication strategy. | Behavioral: behavioral communication strategy<br>* Community Health Workers with an additional tailored behavioral communication strategy.<br>|
| Experimental: Behavioral communication strategy, plus smartphone-based tool<br>Community Health Workers with a tailored behavioral communication strategy, also equipped with smartphone-based tool linked to the AMPATH Medical Record System (AMRS). | Behavioral: Behavioral communication strategy, plus smartphone-based tool<br>* Community Health Workers with a tailored behavioral communication strategy, also equipped with smartphone-based tool linked to the AMPATH Medical Record System (AMRS).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Documented linkage to care following home-based testing | An individual who links to care on his/her own within one month of home-based blood pressure testing will be characterized as self-linked or after a community health worker (CHW) visit, sh/he will be characterized as CHW-mediated linked. | up to 5 years | 
| One year change in systolic blood pressure among hypertensive individuals | One year change in systolic blood pressure among hypertensive individuals. | up to one year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood Pressure controlled | Percentage of hypertensive individuals whose BP is controlled (<140/90) at the final clinic visit | up to 5 years | 
| Medication adherence | Medication adherence will be defined as number of doses taken divided by number of doses prescribed, for the previous one month. | up to 5 years | 
| behavioral changes | Behavioral changes include physical activity, diet (salt, fruit/vegetable intake), and tobacco use. | up to 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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linkage to care, hypertension management, behavioral science, cardiovascular health, global health, multi-disciplinary implementation research approach, linking and retaining, community health workers, CHWs, behavioral communication strategy, smartphone-based tool, electronic health record, retention to care