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.

项目概要/摘要高血压是全球发病率和过早死亡的主要可预防原因，也是一个主要驱动因素撒哈拉以南非洲地区 (SSA) 心血管疾病 (CVD) 负担不断增加。高血压可以使用高效、经济的药物进行控制；然而，在超过 1 亿的人口中 SSA 的高血压患者中，血压得到控制的比例为 10% 或更少，而其他地区的高血压控制率也同样较低艾滋病毒感染者。 SSA 和全球都坚定致力于改善高血压治疗和其他心血管疾病危险因素，通过确保药物供应、利用艾滋病毒长期护理模式以及通过加强初级卫生系统。随着高血压诊断和药物供应的改善，策略需要提高慢性高血压护理模式以患者为中心的程度，以便让患者参与降低 CVD 风险并实现最佳健康结果所需的长期护理。在这个 K23 提案中，我的总体科学目标是评估和测试克服患者的干预措施肯尼亚慢性艾滋病高血压护理模式中高血压治疗依从性的障碍。这该提案嵌套在 NIH 资助的 SEARCH SAPPHIRE 试验 (U01AI150510) 中，评估综合东非的高血压-艾滋病毒护理。在目标 1 中，我将使用基于理论的混合方法来评估 SEARCH 高血压-艾滋病毒综合护理模式中高血压治疗依从性的障碍。在目标 2，我将进行离散选择实验，以评估患者对改善护理策略的偏好交付，利用研究结果制定实施策略，以改善以患者为中心的高血压护理。在目标3，我将进行一项试点研究，以评估该实施策略的可行性和可接受性。我的总体培训目标是发展实施科学方法的专业知识，以改善患者的撒哈拉以南非洲高血压和艾滋病毒综合护理模式的中心性和有效性。我的研究目标与我的具体培训目标相对应：(1) 发展高血压和心血管疾病临床专业知识研究，(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。此 K23 提案响应 NHLBI 战略目标 6，优化临床和实施研究以改善健康并减少疾病。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由 NIH 资助的独立研究者，具有实施科学方法的专业知识，以改善 CVD 和 HIV 结果。该提案产生的结果将通知 NIH R01 申请来测试多改善 SSA 感染者和未感染者高血压治疗结果的策略。