Hypertension Research Programme - HT13

Optimizing linkage and retention to hypertension care in rural Kenya

Project location: Kenya

Project duration: 2012 - 2017

Funding organisation

HT13 project video

Primary research aim

The objective of this project is to utilize a multi-disciplinary implementation research approach to address the challenge of linking and retaining hypertensive individuals to a hypertension management program.

Research objectives and methodology

Identify the facilitators and barriers to linking and retaining individuals with high blood pressure to a hypertension care delivery program, using a combination of qualitative research methods:

Using identified facilitators and barriers, develop a tailored behavioral communication strategy guided by the Health Belief Model.
Using identified facilitators and barriers, develop a smartphone-based tool linked to the AMPATH Medical Record System (AMRS) to be used by CHWs to optimize linkage and retention of hypertensive patients to the care program, and evaluate the usability and feasibility of this tool.
Evaluate the effectiveness of CHWs equipped with a tailored behavioral communication strategy and a smartphone-based tool in improving linkage and reducing blood pressure among hypertensive patients, by conducting a cluster randomized trial comparing.
- Usual care (CHWs with standard training on recruitment of individuals with any chronic condition).
- CHWs with an additional tailored behavioral communication strategy.
- CHWs with a tailored behavioral communication strategy and also equipped with smartphone-based tool linked to the AMRS.
Evaluate the incremental cost-effectiveness of each intervention arm of the cluster randomized trial. The co-primary outcome measures will be:
- Documented linkage to care following home-based testing.
- One year change in systolic blood pressure among hypertensive individuals.

Current status

Aim 1: Barriers and Facilitators to Linkage and Retention

All research related activities are complete
Manuscript published in the Journal of General Internal Medicine in 2016

Aim 1.1: Behavioral Assessment and Communication Strategy

Content validity complete
Manuscript is in preparation

Aim 1.2: Smartphone-based Tool

Study databases/servers (Virtual Machine, AMRS & Redcap) launched
Field implementation of smartphone-based tool underway

Enrollment complete
12-month follow-up visits ongoing
Process evaluation complete
CHW and CHEW training complete
Data Management ongoing

Aim 2: Cluster RCT

Aim 3: Cost-effectiveness analysis

Administration of Costing Questionnaire at 12-month follow-up ongoing
Cost-tracking for intervention delivery ongoing

Project contact: Briana Cortez (New York) and Jackson Rotich

Investigators

Valentin Fuster, Icahn School of Medicine at Mount Sinai, New York, USA
Rajesh Vedanthan, Icahn School of Medicine at Mount Sinai, New York, USA
Jemima Kamano, Moi Teaching and Referral Hospital, Eldorey, Kenya
Sylvester Kimaiyo, Moi Teaching and Referral Hospital, Eldorey, Kenya

Publications

Naanyu V, Vedanthan R, Kamano JH, Rotich J, Lagat K, Kiptoo P, Kofler C, Mutai K, Menya D, Kimaiyo S, Fuster V, Horowitz C, Inui T. Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study. Journal of General Internal Medicine. 2016;31(3):304-14. doi: 10.1007/s11606-015-3566-1.
Vedanthan R, Kamano JH, Naanyu V, Delong AK, Were MC, Finkelstein EA et al. Optimizing linkage and retention to hypertension care in rural Kenya (LARK hypertension study): study protocol for a randomized controlled trial. Trials. 2014;15(1):143. doi:10.1186/1745-6215-15-143.
Blank E, Tuikong N, Misoi L, Kamano J, Hutchinson C, Kimaiyo S et al. Usability of implementing a tablet-based decision support and integrated record- keeping (DESIRE) tool in the nurse management of hypertension in rural Kenya. Stud Health Technol Inform. 2013;192:1002.