Transforming Hypertension Management in Nigeria

改变尼日利亚的高血压管理

• 批准号: 10162412
• 负责人: Mark D Huffman
• 金额: $ 62.33万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-15 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10162412
• 关键词: Address; Adopted; Adoption; Adult; Africa South of the Sahara; African; Algorithms; Awareness; Blood; Blood Pressure; California; Capital; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Chronic; Collaborations; Communities; Community Health Aides; Country; Data; Developing Countries; Disease; Dose; Effectiveness; Effectiveness of Interventions; Environment; Epidemiology; Evaluation; F Factor; Goals; HIV; Health; Health Status; Health care facility; Health system; Heart; Home; Home Blood Pressure Monitoring; Hybrids; Hypertension; Individual; International; Interruption; Intervention; Intervention Studies; Kidney Diseases; Knowledge; Low Prevalence; Maintenance; Medical; Medicine; Methodology; Methods; Modeling; Monitor; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Nigeria; Nigerian; Ophthalmology; Participant; Pathway interactions; Patient-Focused Outcomes; Patients; Performance; Physicians; Policies; Prevalence; Primary Health Care; Public Health; Quality of Care; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Research Design; Risk; Risk Factors; Sampling; Series; Societies; Structure; System; Target Populations; Testing; Time; Titrations; Translating; Translations; Vision; base; blood pressure regulation; burden of illness; clinical practice; cost; data modeling; design; effectiveness evaluation; effectiveness study; evidence base; experience; follow-up; high risk; hypertension control; hypertension treatment; implementation barriers; implementation outcomes; implementation science; implementation strategy; improved; low and middle-income countries; modifiable risk; mortality; multidisciplinary; novel strategies; patient advocacy group; patient oriented; premature; pressure; programs; public health relevance; randomized trial; scale up; societal costs; systematic review; treatment as usual; treatment guidelines

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

项目 抽象的 高架 和 基于 非常 血压（BP）是可改变的危险因素F或全球心血管疾病发病率 死亡。在尼日利亚，撒哈拉以南非洲最普遍的国家，高血压的患病率 在BP阈值> 140/90 mmHg的成年人（> 40年）估计为45％。 1尽管如此 高燃烧，高血压意识（14-30％），治疗（<20％）和对照（9％）的率很低 s 尼日利亚。 2 2018年对119次试验的系统审查（n = 55,641名参与者）评估实施策略 为了改善BP控制 BP降低药物的滴定是降低收缩BP的最有效方法（-7.1 mmHg [95％ CI：-8.9，-5.2]，10个试验）.3降低收缩压的最有效的以患者为中心的干预措施是健康 教练（-3.9 mmhg [95％CI：-5.4，-2.3]，38个试验）和家庭BP监控（-2.7 mmHg [95％CI：-3.6，-1.7]， 26个试验）。重要的是，这项系统评价的研究中<20％来自低收入和中等收入 国家，没有一个来自撒哈拉以南非洲。 将这些发现转化为常规临床实践需要系统来跟踪患者，表现 审查，算法，医生将控制权控制给非医师，而非医师将控制权控制到和 支持患者，就像艾滋病毒护理在整个撒哈拉以南非洲的结构一样。我们的飞行员数据（n = 60） 尼日利亚从阿布贾（Abuja）表现出可行性和短期效率，以降低1个月的收缩压 通过社区卫生工作者领导的护理（-10.5 mmhg [95％CI：-15.4，-5.5]）和家庭BP监控（-7.3 与通常的护理相比，MMHG [95％CI：-11.7，-2.8]）。 在此提案中，我们将利用实施科学方法，包括覆盖效果 采用实施维护（RE-AIM）框架以适应，实施和评估证据 - 基于多级干预，包括：（1）系统级高血压计划改编自Kaiser 北加州北加州的永久模型在联邦首都地区的基本卫生保健机构 [Abuja]，尼日利亚和（2）在高风险样本中进行家庭BP监控的患者级健康教练 不受控制的高血压患者。我们将研究这些适应的有效性和实施 通过中断的时间序列设计进行高血压治疗和控制率的干预措施，以及 以患者为中心的结果。我们 作为 还将使用RE-AIM框架评估实现结果， 以及两种干预措施的系统和患者水平的可接受性和成本。该提案直接解决NHLBI战略愿景的关键挑战＃11：“多学科， 需要跨国伙伴关系来制定有效和可持续的策略来对抗慢性 发展中国家中的HLBS疾病，考虑到HLB的局部流行病学高度可变 疾病，对减少疾病伯恩疾病的新方法的需求以及实施的挑战。” 4