Optimizing linkage and retention to hypertension care in rural Kenya

Background

Cardiovascular disease (CVD) is the leading cause of death in sub-Saharan Africa among adults above age 30. The prevalence of hypertension, a major risk factor for CVD, is increasing over time in sub-Saharan Africa, exerting a significant epidemiologic and economic burden on the region. Without adequate control of hypertension, its health and economic burden will increase drastically in the decades ahead. Well established and evidence-based interventions to manage hypertension exist; however, treatment and control rates are low. A critical component of hypertension management is to facilitate sustained access of affected individuals to effective clinical services. In partnership with the Government of Kenya, the United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership (AMPATH) is expanding its clinical scope of work in rural western Kenya to include hypertension and other chronic diseases. However, linking and retaining individuals with elevated blood pressure to the clinical care program has been difficult.

Aims

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

Project plan

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. Co-primary outcome measures:

  • Documented linkage to care following home-based testing.

  • One year change in systolic blood pressure among hypertensive individuals.

Impact

The project showed that the strategy, which combined tailored behaviour change communication and mHealth for community health workers could lead to led to improved linkage to care for patients with hypertension, showing a trend towards improvements in blood pressure among individuals who received the intervention.

Publications and output

GACD have published an end-of-programme report providing a comprehensive summary of the programme and outcomes.

Principal investigators

Team members

Funding organisations

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