Hypertension Research Programme - HT12
Task shifting and blood pressure control in Ghana - a cluster-randomized trial
Project location: Ghana
Project duration: 2012 - 2017
Primary research aim
in sub-Saharan Africa (SSA) are experiencing an epidemic of
cardiovascular disease (CVD) propelled by rapidly increasing rates of
hypertension. Barriers to hypertension control in SSA include poor
access to care and high out-of-pocket costs. Although SSA bears 24% of
the global disease burden, it has only 3% of the global health
workforce. Given such limited resources, cost-effective strategies, such
as task shifting, are needed to mitigate the rising CVD epidemic in
SSA. Ghana, a country in SSA with an established community health worker
program integrated within a national health insurance scheme provides
an ideal platform to evaluate implementation of the World Health
Organization (WHO) task-shifting strategy. This study will evaluate the
comparative effectiveness of the implementation of the WHO Package
targeted at CV risk assessment versus provision of health insurance
coverage, on blood pressure (BP) reduction.
Research objectives and methodology
a cluster randomized design, 32 community health centers (CHCs) and
district hospitals in Ghana will be randomized to either the
intervention group (16 sites) or the control group (16 sites). A total
of 640 patients with uncomplicated hypertension (BP 140-179/90-99 mmHg
and absence of target organ damage) will be enrolled in this study (20
patients per site). The intervention consists of WHO Package of CV risk
assessment, patient education, initiation and titration of
antihypertensive medications, behavioral counselling on lifestyle
behaviours, and medication adherence every three months for 12 months.
The primary outcome is the mean change in systolic BP from baseline to
12 months. The secondary outcomes are rates of BP control at 12 months;
levels of physical activity, percent change in weight, and dietary
intake of fruits and vegetables at 12 months; and sustainability of
intervention effects at 24 months. All outcomes will be assessed at
baseline, six months and 12 months. Trained community health nurses will
deliver the intervention as part of Ghana’s community-based health
planning and services (CHPS) program. Findings from this study will
provide policy makers and other stakeholders needed information to
recommend scalable and cost-effective policy with respect to
comprehensive CV risk reduction and hypertension control in
have recruited and randomized all 32 health facilities (16 district
hospitals, 16 health centers) into four cohorts. We have completed
baseline recruitment with a total of 757 patients. Final patient
recruitment was ~18% more than the estimated recruitment target of 640.
Follow-up is almost completed for the first cohort of eight sites with a
total of 198 patients. We are currently working on patient follow-up
for all four cohorts.
Project contact: Joyce Gyamfi - email@example.com
- Olugbenga Ogedegbe, New York University Medical Center, New York, USA
- Joyce Gyamfi, New York University Medical Center, New York, USA
- Jacob Plange-Rhule, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Michael Ntim, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kingsley Apusiga, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Richard Cooper, Loyola University Health System, USA
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- W Tobe S; Global Alliance for Chronic Diseases Hypertension Research Teams With the World Hypertension League. The Global Alliance for Chronic Diseases Supports 15 Major Studies in Hypertension Prevention and Control in Low- and Middle-Income Countries. J Clin Hypertens (Greenwich). 2016 Jul; 18(7):600-5. doi: 10.1111/jch.12835. Epub 2016 Jun 1.
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- Iwelunmor J, Plange-Rhule J, Airhihenbuwa CO, Ezepue C, Ogedegbe O. A Narrative Synthesis of the Health Systems Factors Influencing Optimal Hypertension Control in Sub-Saharan Africa. PLOS ONE. 2015 Jul 15; 10(7):e0130193. doi: 10.1371/journal.pone.0130193.
- Iwelunmor J, Blackstone S, Gyamfi J, Airhihenbuwa C, Plange-Rhule J, Tayo B, Adanu R, , Ogedegbe G. A concept mapping study of physicians’ perceptions of factors influencing management and control of hypertension in Sub-Saharan Africa. Int J Hypertens. 2015;2015:412804. doi: 10.1155/2015/412804. Epub 2015 Oct 13.
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- Ogedegbe G, Gyamfi J, Plange-Rhule J, Surkis A, Rosenthal DM, Airhihenbuwa C, Iwelunmor J, Cooper R. Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials. BMJ open. 2014; 4(10):e005983. doi: 10.1136/bmjopen-2014-005983.
- Ogedegbe G, Plange-Rhule J, Gyamfi J, Chaplin W, Ntim M, Apusiga K, Khurshid K, Cooper R. A cluster-randomized trial of task shifting and blood pressure control in Ghana: study protocol. Implement Sci. 2014; 9:73. doi: 10.1186/1748-5908-9-73.