[R01] The ADHINCRA Study: Addressing HypertensIoN Care in AfRicA
Ente: National Heart Lung and Blood Institute
Scadenza: 2029-06-30
Importo max: 369.846 EUR
Paese: US
Descrizione
Project Summary/Abstract
Innovation in chronic disease management is urgently needed to effectively control hypertension (HTN) in Ghana and
Nigeria . challenges that closely mirror those facing Black and African immigrant communities in the US. Both
countries are experiencing silent epidemics of chronic disease with rates resembling those of high-income countries, and
the patient-, provider-, and system-level barriers driving poor HTN control in Africa parallel those in under-resourced
U.S. communities. A pressing global health challenge with direct U.S. implications is implementing evidence-based,
contextually appropriate strategies to improve HTN management across these settings through reciprocal innovation.
Multilevel interventions improve HTN control. For instance, team-based care, a health systems-level and organizational
intervention, improves the quality of HTN care. Telehealth can be enhanced with home blood pressure monitoring
(HBPM) to address patient-, and provider-level barriers. The Luscii app, a remote telemonitoring app that links with
validated blood pressure (BP) and glucose monitoring devices, is a promising solution to improve patientsf selfmanagement
of hypertension across resource settings. In a previous pilot, we investigated the impact of a multilevel and
digitally-enabled home-based intervention compared to enhanced usual care (UC). After 12 months, 80.5% in the
intervention arm, compared to 24.2% in the enhanced UC arm, had controlled BP (p <0.001). Given the promising
findings, we designed a larger scale trial, consisting of an innovative multilevel intervention linking HBPM with a
telemonitoring platform (Luscii app), team-based care including physicians and nurses, and the use of a simplified
hypertension treatment protocol at hospitals, to improve HTN control. Using a hybrid type 2 effectiveness-implementation
design among 800 adults with uncontrolled HTN clustered in 16 hospitals across 4 regions (Ashanti, Northern, Volta, and
Bono) in Ghana and in Ondo State, Nigeria, we seek to 1) Assess the effect of the ADHINCRA Program in improving BP
control at 12 months using a stepped wedge cluster randomized trial of adults with uncontrolled HTN (systolic BP .140
mm Hg) and 2) Use the Pragmatic Robust Implementation and Sustainability Model (PRISM) to evaluate the reach,
adoption, and maintenance of the ADHINCRA Program at 12- and 18-months post-randomization and explore contextual
factors that are associated with the adoption and maintenance of the program in each site using the Service Availability
and Readiness Assessment tool. We seek to close the wide know-do gap, reduce chronic disease disparities in Africa and
the U.S., and generate scalable models of nurse-led, digitally-enabled hypertension care with bidirectional global
applicability.
Istituzione: JOHNS HOPKINS UNIVERSITY
PI: Yvonne Commodore-Mensah, Dike Bevis Ojji, Fred Stephen Sarfo
Progetto: 5R01HL175642-03
Settori: National Heart Lung and Blood Institute
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