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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

  • Behavioral Assessment tools and Communication Strategy finalized.
  • Enrollment ongoing.
  • Tablets for Research Assistants, and Smartphones, protective covers and sim cards for the Community Health Workers have been procured. Other items procured: Blood Pressure Machines, weight/height meter scales.
  • mUzima platform has been developed and is operational.
  • Protocol for usability and feasibility testing has been finalized.
  • Trainings of the Community Health Workers and Community Health Extension Workers on: Overview of LARK study, Hypertension, Behavioral Assessment tools and Communication Strategy as well as Motivational Interviewing has been carried out.
  • Roll-out and trainings in usual care arms and paper-based arms have been completed.
  • Data collection process is ongoing.
  • Data entry process is ongoing.
  • Data management cleaning is ongoing.
  • Programming of the behavioral assessment questionnaires is near finalized.
  • Roll-out exercise for smartphone arm to be initiated once programming is done (anticipated tech arm roll-out initiation in March 2015).
  • Development of process evaluation protocol has been finalized and submitted to ethic boards for approval.
  • LARK Qualitative manuscript #1 is nearly complete.
  • LARK Qualitative manuscript #2 has been initiated.

Project contact: Clare Kofler (New York) and Jackson Rotich



  1. 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.
  2. 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.
  3. 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.