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Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial

BACKGROUND: Over 80% of the morbidity and mortality related to non-communicable diseases (NCDs) occurs in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, particularly in sub-Sahara...

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Autores principales: Ingenhoff, Rebecca, Nandawula, Juliet, Siddharthan, Trishul, Ssekitoleko, Isaac, Munana, Richard, Bodnar, Benjamin E., Weswa, Ivan, Kirenga, Bruce J., Mutungi, Gerald, van der Giet, Markus, Kalyesubula, Robert, Knauf, Felix
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9128241/
https://www.ncbi.nlm.nih.gov/pubmed/35610712
http://dx.doi.org/10.1186/s13063-022-06403-9
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author Ingenhoff, Rebecca
Nandawula, Juliet
Siddharthan, Trishul
Ssekitoleko, Isaac
Munana, Richard
Bodnar, Benjamin E.
Weswa, Ivan
Kirenga, Bruce J.
Mutungi, Gerald
van der Giet, Markus
Kalyesubula, Robert
Knauf, Felix
author_facet Ingenhoff, Rebecca
Nandawula, Juliet
Siddharthan, Trishul
Ssekitoleko, Isaac
Munana, Richard
Bodnar, Benjamin E.
Weswa, Ivan
Kirenga, Bruce J.
Mutungi, Gerald
van der Giet, Markus
Kalyesubula, Robert
Knauf, Felix
author_sort Ingenhoff, Rebecca
collection PubMed
description BACKGROUND: Over 80% of the morbidity and mortality related to non-communicable diseases (NCDs) occurs in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, particularly in sub-Saharan African settings. In Uganda, and the majority of LMICs, management of uncontrolled hypertension remains limited in constrained health systems. Intervening at the primary care level, using CHWs to improve medical treatment outcomes has not been well studied. We aim to determine the effectiveness of a CHW-led intervention in blood pressure control among confirmed hypertensive patients and patient-related factors associated with uncontrolled hypertension. METHODS: We will conduct a stepped-wedge cluster randomized controlled trial study of 869 adult patients with hypertension attending two NCD clinics to test the effectiveness, acceptability, and fidelity of a CHW-led intervention. The multi-component intervention will be centered on monthly household visits by trained CHWs for a period of 1 year, consisting of the following: (1) blood pressure and sugar monitoring, (2) BMI monitoring, (3) cardiovascular disease risk assessment, (4) using checklists to guide monitoring and referral to clinics, and (5) healthy lifestyle counseling and education. During home visits, CHWs will remind patients of follow-up visits. We will measure blood pressure at baseline and 3-monthly for the entire cohort. We will conduct individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community. CONCLUSION: The results of this study will inform community delivered HTN management across a range of LMIC settings. TRIAL REGISTRATION: ClinicalTrials.govNCT05068505. Registered on October 6, 2021.
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spelling pubmed-91282412022-05-25 Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial Ingenhoff, Rebecca Nandawula, Juliet Siddharthan, Trishul Ssekitoleko, Isaac Munana, Richard Bodnar, Benjamin E. Weswa, Ivan Kirenga, Bruce J. Mutungi, Gerald van der Giet, Markus Kalyesubula, Robert Knauf, Felix Trials Study Protocol BACKGROUND: Over 80% of the morbidity and mortality related to non-communicable diseases (NCDs) occurs in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, particularly in sub-Saharan African settings. In Uganda, and the majority of LMICs, management of uncontrolled hypertension remains limited in constrained health systems. Intervening at the primary care level, using CHWs to improve medical treatment outcomes has not been well studied. We aim to determine the effectiveness of a CHW-led intervention in blood pressure control among confirmed hypertensive patients and patient-related factors associated with uncontrolled hypertension. METHODS: We will conduct a stepped-wedge cluster randomized controlled trial study of 869 adult patients with hypertension attending two NCD clinics to test the effectiveness, acceptability, and fidelity of a CHW-led intervention. The multi-component intervention will be centered on monthly household visits by trained CHWs for a period of 1 year, consisting of the following: (1) blood pressure and sugar monitoring, (2) BMI monitoring, (3) cardiovascular disease risk assessment, (4) using checklists to guide monitoring and referral to clinics, and (5) healthy lifestyle counseling and education. During home visits, CHWs will remind patients of follow-up visits. We will measure blood pressure at baseline and 3-monthly for the entire cohort. We will conduct individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community. CONCLUSION: The results of this study will inform community delivered HTN management across a range of LMIC settings. TRIAL REGISTRATION: ClinicalTrials.govNCT05068505. Registered on October 6, 2021. BioMed Central 2022-05-24 /pmc/articles/PMC9128241/ /pubmed/35610712 http://dx.doi.org/10.1186/s13063-022-06403-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Study Protocol
Ingenhoff, Rebecca
Nandawula, Juliet
Siddharthan, Trishul
Ssekitoleko, Isaac
Munana, Richard
Bodnar, Benjamin E.
Weswa, Ivan
Kirenga, Bruce J.
Mutungi, Gerald
van der Giet, Markus
Kalyesubula, Robert
Knauf, Felix
Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial
title Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial
title_full Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial
title_fullStr Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial
title_full_unstemmed Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial
title_short Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial
title_sort effectiveness of a community health worker-delivered care intervention for hypertension control in uganda: study protocol for a stepped wedge, cluster randomized control trial
topic Study Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9128241/
https://www.ncbi.nlm.nih.gov/pubmed/35610712
http://dx.doi.org/10.1186/s13063-022-06403-9
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