학술논문
Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial.
Document Type
Academic Journal
Author
Ingenhoff R; Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. rebecca.ingenhoff@charite.de.; Nandawula J; African Community Center for Social Sustainability, Nakaseke, Uganda.; Siddharthan T; Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, USA.; Ssekitoleko I; MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda.; London School of Hygiene and Tropical Medicine, London, UK.; Munana R; African Community Center for Social Sustainability, Nakaseke, Uganda.; School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.; Bodnar BE; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Weswa I; African Community Center for Social Sustainability, Nakaseke, Uganda.; Kirenga BJ; Makerere University Lung Institute, Kampala, Uganda.; Mutungi G; Ministry of Health, Kampala, Uganda.; van der Giet M; Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.; Kalyesubula R; African Community Center for Social Sustainability, Nakaseke, Uganda.; Department of Physiology, Uganda Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda.; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.; Knauf F; Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
Source
Publisher: BioMed Central Country of Publication: England NLM ID: 101263253 Publication Model: Electronic Cited Medium: Internet ISSN: 1745-6215 (Electronic) Linking ISSN: 17456215 NLM ISO Abbreviation: Trials Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Over 80% of the morbidity and mortality related to non-communicable diseases (NCDs) occurs in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, particularly in sub-Saharan African settings. In Uganda, and the majority of LMICs, management of uncontrolled hypertension remains limited in constrained health systems. Intervening at the primary care level, using CHWs to improve medical treatment outcomes has not been well studied. We aim to determine the effectiveness of a CHW-led intervention in blood pressure control among confirmed hypertensive patients and patient-related factors associated with uncontrolled hypertension.
Methods: We will conduct a stepped-wedge cluster randomized controlled trial study of 869 adult patients with hypertension attending two NCD clinics to test the effectiveness, acceptability, and fidelity of a CHW-led intervention. The multi-component intervention will be centered on monthly household visits by trained CHWs for a period of 1 year, consisting of the following: (1) blood pressure and sugar monitoring, (2) BMI monitoring, (3) cardiovascular disease risk assessment, (4) using checklists to guide monitoring and referral to clinics, and (5) healthy lifestyle counseling and education. During home visits, CHWs will remind patients of follow-up visits. We will measure blood pressure at baseline and 3-monthly for the entire cohort. We will conduct individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community.
Conclusion: The results of this study will inform community delivered HTN management across a range of LMIC settings.
Trial Registration: ClinicalTrials.gov NCT05068505 . Registered on October 6, 2021.
(© 2022. The Author(s).)
Methods: We will conduct a stepped-wedge cluster randomized controlled trial study of 869 adult patients with hypertension attending two NCD clinics to test the effectiveness, acceptability, and fidelity of a CHW-led intervention. The multi-component intervention will be centered on monthly household visits by trained CHWs for a period of 1 year, consisting of the following: (1) blood pressure and sugar monitoring, (2) BMI monitoring, (3) cardiovascular disease risk assessment, (4) using checklists to guide monitoring and referral to clinics, and (5) healthy lifestyle counseling and education. During home visits, CHWs will remind patients of follow-up visits. We will measure blood pressure at baseline and 3-monthly for the entire cohort. We will conduct individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community.
Conclusion: The results of this study will inform community delivered HTN management across a range of LMIC settings.
Trial Registration: ClinicalTrials.gov NCT05068505 . Registered on October 6, 2021.
(© 2022. The Author(s).)