Community Health Worker Led Hypertension Prevention and Control (CHPC) in Nepal: An Implementation Trial

尼泊尔社区卫生工作者主导的高血压预防和控制 (CHPC)：实施试验

• 批准号: 10719933
• 负责人: DONNA L SPIEGELMAN
• 金额: $ 61.36万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10719933
• 关键词: Address; Adopted; Adult; Alcohols; Antihypertensive Agents; Awareness; Behavioral; Belief; Blood Pressure; Blood Pressure Monitors; Blood Vessels; Body Weight decreased; Cessation of life; Client; Communities; Community Health Aides; Community Healthcare; Coronary heart disease; Data; Diastolic blood pressure; Disease; Eating; Economics; Effectiveness; Event; Evidence based intervention; Expenditure; Geography; Government; Health; Health Personnel; Health care facility; Health system; Healthcare Systems; High Prevalence; Home; Household; Human Resources; Hybrids; Hypertension; Individual; Intake; Interruption; Life Style; Life Style Modification; Measures; Medicine; Methods; Modeling; Nepal; Outcome; Participant; Patients; Peer Pressure; Pharmaceutical Preparations; Physical activity; Positioning Attribute; Predisposition; Prevalence; Prevention; Primary Health Care; Primary Prevention; Protocols documentation; Provider; Public Health; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Reporting; Resource-limited setting; Risk Factors; Secondary Prevention; Self Efficacy; Sodium; Stroke; Time; Translating; blood pressure control; blood pressure reduction; cardiovascular disorder risk; comparative; cost; cost effectiveness; effectiveness evaluation; effectiveness/implementation study; empowerment; experience; fruits and vegetables; good diet; high salt diet; hypertension control; hypertension prevention; hypertension treatment; implementation barriers; implementation evaluation; implementation outcomes; implementation science; implementation strategy; implementation trial; improved; incremental cost; low and middle-income countries; low health literacy; medical supply; medication compliance; mortality; physical inactivity; population health; premature; prevent; primary outcome; public health priorities; recruit; response; saturated fat; secondary outcome; standard of care; uptake

ABSTRACT In Nepal, the prevalence of HTN among adults is 25% is similar to the global prevalence. In Nepal, however, a comparatively larger proportion of adults (44%) are unaware of their HTN status, 33% of HTN patients are receiving treatment, and only 12% of the patients have their BP under control. Despite the availability of proven effective lifestyle changes and low-cost anti-HTN treatment in preventing major vascular events and total mortality, these recommendations have not been translated into practice. In Nepal, the Package of Essential Non Communicable Diseases (PEN) was adopted that includes protocols to detect and manage HTN at the basic health facilities However, major implementation barriers at multiple levels exists: (a) Individual level: low perceived susceptibility, low health literacy, misconceptions; (b) Interpersonal level: peer pressure; (c) Community level: norms supporting unhealthy eating and low medication adherence; and (d) Organizational level: unfilled human resource positions, overburdened health staff, interrupted medical supplies and medicines; inefficient recording and reporting, and inadequate provider-patient interaction. In response to these multi-level implementation barriers, we propose to implement and evaluate a new task-shifting strategy to community health workers (CHW), leading to improved HTN prevention and control. CHWs will : (a) engage with and educate clients more frequently, for longer periods, and in their homes, hence building clients' self- efficacy; (b) improve health system efficiency by providing quality provider-client time to modify lifestyle, monitor blood pressure; and (c) CHWs will directly connect the HTN patients with health care providers at health facilities through time referral. We will conduct a type III hybrid effectiveness-implementation study to implement and evaluate a CHW led HTN prevention and control (CHPC) implementation strategy to deliver increased uptake and sustainment of healthy diet, physical activity, and antihypertensive medication use; leading to lowering of blood pressure.Aim 1 will assessimplementation outcomes of CHPC implementation strategy using the RE-AIM framework at the patient, provider and health system levels. We will utilize mixed methods to measure the Reach, Effectiveness, Adoption, Implementation and Maintenance outcomes for sustained implementation of CHPC. Aim 2 will assess the effectiveness of the CHPC implementation strategy compared to facility-based PEN on systolic BP via a cluster randomized controlled trial. We will recruit 2432 participants with high blood pressure in 171 geographic clusters randomized to assess CHPC on systolic BP (primary outcome). Aim 3 will evaluate the economic sustainability of CHPC. We will collect primary cost data from facilities and participants and use the effectiveness estimate from aim 2 to model the costs and cost- effectiveness and household out of pocket expenditure impacts. If successful, this study will provide the governments of Nepal and other LMICs a HTN prevention and control strategy to mitigate the burden of HTN in low resource settings.

抽象的 在尼泊尔，成年人中HTN的患病率为25％，类似于全球患病率。然而，在尼泊尔 相对较大的成年人比例（44％）不知道其HTN状态，33％的HTN患者是 接受治疗，只有12％的患者可以控制其BP。尽管有可靠的 有效的生活方式改变和低成本的抗HTN治疗，以防止重大血管事件和全部 死亡率，这些建议尚未将其转化为实践。在尼泊尔，必需品包 采用了非传染病（笔） 包括 检测和管理HTN的协议 但是，基本的健康设施，存在多个层次的主要实施障碍：（a）个体级别：低 感知的易感性，健康素养低，误解； （b）人际关系：同伴压力； （C） 社区层面：支持不健康的饮食和低药物依从性的规范； （d）组织 级别：未填补的人力资源职位，负担重大的健康人员，中断的医疗用品和 药物;效率低下的记录和报告以及提供者与患者互动不足。回应这些 多级实施障碍，我们建议实施和评估一种新的任务转换策略 社区卫生工作者（CHW），可改善HTN的预防和控制。 CHW将：（a）参与 在更长的时间内和在家中更频繁地教育客户，因此建立客户的自我 功效; （b）通过提供质量提供商的时间来改变生活方式，提高卫生系统效率， 监测血压； （c）CHW将直接将HTN患者与医疗保健提供者联系起来 卫生设施通过时间推荐。我们将进行III型混合有效性研究研究 实施和评估CHW LED HTN预防和控制（CHPC）实施策略 健康饮食，体育锻炼和使用降压药的摄取和维持； 导致血压降低。IAM1将评估CHPC实施的图像结果 使用RE-AIM框架的策略，提供者和卫生系统水平。我们将使用混合 测量覆盖范围，有效性，采用，实施和维护成果的方法 CHPC的持续实施。 AIM 2将评估CHPC实施策略的有效性 与基于设施的笔在收缩BP上的笔相比，通过簇随机对照试验。我们将招募2432 171个地理簇中的高血压参与者随机评估收缩期BP的CHPC （主要结果）。 AIM 3将评估CHPC的经济可持续性。我们将收集主要成本数据 来自设施和参与者，并利用AIM 2的有效估计来建模成本和成本 - 有效性和家庭不受欢迎的影响。如果成功，这项研究将提供 尼泊尔和其他LMIC的政府预防和控制策略，以减轻HTN的负担 资源设置低。