Implementation Strategies to Improve Hypertension Treatment in Kenya

改善肯尼亚高血压治疗的实施策略

基本信息

批准号：
10659258
负责人：
Matthew Hickey
金额：
$ 20.12万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-05 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10659258
关键词：
Address Adherence Adult Africa Africa South of the Sahara Blood Pressure Cardiovascular Diseases Caring Center for Translational Science Activities Chronic Chronic Care Clinic Clinic Visits Clinical Clinical Research Data Diagnosis Disease Effectiveness Ensure Evaluation Evidence based intervention Funding Goals Guidelines HIV Health Health Personnel Health system Hypertension Intervention Interview Kenya Learning Long-Term Care Maps Mentors Mentorship Methods Modeling Morbidity - disease rate National Heart, Lung, and Blood Institute Outcome Patient Preferences Patient-Focused Outcomes Patients Persons Pharmaceutical Preparations Pilot Projects Population Premature Mortality Process Proctor framework Provider Public Health Research Research Methodology Research Personnel Risk Factors Rural Sampling Site Structure Surveys Testing Theoretical Domains framework Training Treatment outcome Uganda United States National Institutes of Health Well in self acceptability and feasibility behavior change wheel blood pressure control cardiovascular disorder prevention cardiovascular disorder risk care delivery care systems chronic care model cost effective design experience experimental study hypertension control hypertension treatment hypertensive implementation barriers implementation outcomes implementation research implementation science implementation strategy improved integrated care medication compliance mortality patient engagement patient oriented patient-level barriers pilot test pragmatic trial preference secondary outcome skills theories therapy development treatment adherence

项目摘要

PROJECT SUMMARY/ABSTRACT Hypertension is the leading preventable cause of morbidity and premature mortality globally and is a major driver of the rising burden of cardiovascular disease (CVD) in sub-Saharan Africa (SSA). Hypertension can be controlled with highly efficacious, cost-effective medications; however, of the over 100 million people with hypertension in SSA, 10% or fewer have controlled blood pressure, with similar low rates of control among people with HIV. There is a strong commitment both in SSA and globally to improve treatment for hypertension and other CVD risk factors by ensuring medication supply, by leveraging the HIV chronic care model, and via primary health system strengthening. As hypertension diagnosis and medication availability improve, strategies are needed to increase patient-centeredness of chronic hypertension care models in order to engage patients in the long-term care required to reduce CVD risk and achieve optimal health outcomes. In this K23 proposal, my overall scientific objective is to assess, and test interventions that overcome, patient- level barriers to hypertension treatment adherence in a chronic HIV-hypertension care model in Kenya. This proposal is nested within the NIH-funded SEARCH SAPPHIRE trial (U01AI150510) evaluating integrated hypertension-HIV care in East Africa. In Aim 1, I will use a theory-informed mixed methods approach to evaluate barriers to hypertension treatment adherence within the SEARCH integrated hypertension-HIV care model. In Aim 2, I will conduct a discrete choice experiment to assess patient preferences for strategies to improve care delivery, using findings to develop an implementation strategy to improve patient-centered hypertension care. In Aim 3, I will conduct a pilot study to assess feasibility and acceptability of this implementation strategy. My overall training objective is to develop expertise in implementation science approaches to improve the patient- centeredness and effectiveness of integrated care models for hypertension and HIV in sub-Saharan Africa. My research aims map to my specific training objectives to: (1) develop expertise in hypertension and CVD clinical research, (2) learn mixed methods applications in implementation science, (3) learn implementation science methods for intervention development and evaluation. This K23 proposal is responsive to NHLBI Strategic Objective 6, to optimize clinical and implementation research to improve health and reduce disease. My proposed training and research aims will equip me with the necessary skills to achieve my long-term goal of becoming an independent NIH-funded investigator with expertise in implementation science methods to improve CVD and HIV outcomes. Findings generated from this proposal will inform an NIH R01 application to test a multi- component strategy for improving hypertension treatment outcomes among people with and without HIV in SSA.

项目摘要/摘要高血压是全球发病率和过早死亡率的可预防原因，并且是主要驱动因素撒哈拉以南非洲（SSA）的心血管疾病（CVD）的负担上升。高血压可以由高效，具有成本效益的药物控制；但是，有超过1亿人 SSA的高血压，10％或更少的血压受控，在相似的低控制率患有艾滋病毒的人。 SSA和全球都有坚定的承诺，以改善高血压的治疗和其他CVD风险因素，通过确保药物供应，利用HIV慢性护理模型以及通过一级卫生系统加强。随着高血压诊断和药物的可用性的提高，策略需要增加慢性高血压护理模型的患者中心，以使患者参与减少CVD风险并实现最佳健康结果所需的长期护理。在这项K23提案中，我的整体科学目标是评估和测试干预措施，以克服患者 - 在肯尼亚的慢性HIV-Hypertension Care模型中，高血压治疗依从性的水平障碍。这提案嵌套在NIH资助的搜索蓝宝石试验（U01AI150510）中，评估了整合东非的高血压hiv护理。在AIM 1中，我将使用理论上的混合方法方法来评估搜索综合高血压HIV护理模型中高血压治疗依从性的障碍。在 AIM 2，我将进行一个离散的选择实验，以评估患者的偏好，以改善护理的策略交付，使用发现制定实施策略，以改善以患者为中心的高血压护理。在 AIM 3，我将进行一项试点研究，以评估此实施策略的可行性和可接受性。我的整体培训目标是开发实施科学方法的专业知识，以改善患者 - 撒哈拉以南非洲高血压和艾滋病毒综合护理模型的中心和有效性。我的研究目标旨在我的特定培训目标：（1）发展高血压和CVD临床方面的专业知识研究，（2）学习实施科学中的混合方法应用，（3）学习实施科学干预开发和评估的方法。该K23提案对NHLBI战略有回应目标6，以优化临床和实施研究以改善健康和减少疾病。我的拟议的培训和研究目标将使我具备必要的技能，以实现我的长期目标成为一名独立NIH资助的研究者，具有实施科学方法的专业知识以改进 CVD和HIV结果。该提案产生的发现将告知NIH R01申请，以测试多个 SSA中有和没有HIV的患者的高血压治疗结果的组成策略。