The ANDES Study: Addressing HyperteNsion and Diabetes through Community-Engaged Systems in Puno, Peru

Background

Hypertension (HTN) and has become the largest driver of morbidity and mortality (M&M) worldwide, affecting nearly 1 billion persons, the vast majority living in low- and middle-income countries (LMICs). While clinical research has identified highly-efficacious and inexpensive options to control HTN, rates of awareness, treatment and control of HTN are abysmally low. Implementation strategies that can effectively reach and engage patient populations while feasible within the constraints of frail health systems are urgently needed. In Peru, less than 10% of those with HTN are optimally controlled and thus avoidable M&M continues to increase at unacceptable levels. In the ANDES strategy, we studied a vulnerable, impoverished indigenous Andean population that has a high prevalence of HTN (18.5%) and T2D (7.4%).

Aims

This was a cluster randomized trial that aimed to provide compelling, robust evidence on the effects of a multicomponent intervention aimed at reducing blood pressure levels in a high-risk, vulnerable population in Puno, Peru. These data were urgently needed to inform policies in low- and middle-income countries on the health gains that can be obtained by implementation strategies geared towards reducing reduce hypertension among vulnerable populations.

Project plan

The study had two phases: The first phase undertook a formal adaptation process of two implementation strategies: i) health fairs and ii) a community health worker-based multicomponent intervention. The second phase piloted the adapted interventions via a cluster randomised trial. The project assessed implementation fidelity, engagement in care, cost, and sustainability.

Impact

The regional office of the Ministry of Health used evidence gathered by the project to reorganize resources and supplies for the management of hypertension and diabetes in the region of Puno, Peru.

Funding organisations

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