TY - JOUR
T1 - A cluster-randomized trial of task shifting and blood pressure control in Ghana
T2 - Study protocol
AU - Ogedegbe, Gbenga
AU - Plange-Rhule, Jacob
AU - Gyamfi, Joyce
AU - Chaplin, William
AU - Ntim, Michael
AU - Apusiga, Kingsley
AU - Khurshid, Kiran
AU - Cooper, Richard
N1 - Funding Information:
The authors would like to thank the Regional Health Directorate especially Dr. Kwasi Yeboah-Awudzi, who assisted with recruitment of the community health centers and staffing of the CHCs with community health nurses. The authors are grateful to the community health nurses and the team of research assistants at Kwame Nkrumah University of Science and Technology (KNUST) for their work on this project. The ‘Task Shifting and Blood Pressure Control in Ghana: A cluster-randomized trial’ project is funded by the National Institute of Health (grant# U01HL114198) as part of the Global Alliance for Chronic Diseases (GACD) program.
PY - 2014/6/12
Y1 - 2014/6/12
N2 - Background: Countries 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.Methods: Using a cluster randomized design, 32 community health centers (CHCs) and district hospitals in Ghana will be randomized to either the intervention group (16 CHCs) or the control group (16 CHCs). A total of 640 patients with uncomplicated hypertension (BP 140-179/90-99 mm Hg and absence of target organ damage) will be enrolled in this study (20 patients per CHC). The intervention consists of WHO Package of CV risk assessment, patient education, initiation and titration of antihypertensive medications, behavioral counseling on lifestyle behaviors, 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.Discussion: 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 resource-poor settings.Trial registration: NCT01802372.
AB - Background: Countries 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.Methods: Using a cluster randomized design, 32 community health centers (CHCs) and district hospitals in Ghana will be randomized to either the intervention group (16 CHCs) or the control group (16 CHCs). A total of 640 patients with uncomplicated hypertension (BP 140-179/90-99 mm Hg and absence of target organ damage) will be enrolled in this study (20 patients per CHC). The intervention consists of WHO Package of CV risk assessment, patient education, initiation and titration of antihypertensive medications, behavioral counseling on lifestyle behaviors, 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.Discussion: 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 resource-poor settings.Trial registration: NCT01802372.
KW - Blood pressure control
KW - Cluster randomized controlled trial
KW - Community health centers
KW - Community health nurses
KW - Ghana
KW - Hypertension
KW - Task shifting
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U2 - 10.1186/1748-5908-9-73
DO - 10.1186/1748-5908-9-73
M3 - Article
C2 - 24923300
AN - SCOPUS:84902586621
SN - 1748-5908
VL - 9
JO - Implementation Science
JF - Implementation Science
IS - 1
M1 - 73
ER -