A cluster-randomized trial of task shifting and blood pressure control in Ghana: study protocol

Implementation Science

Richard Cooper²  Kiran Khurshid¹  Kingsley Apusiga⁴  Michael Ntim⁴  William Chaplin¹  Joyce Gyamfi³  Jacob Plange-Rhule⁴  Gbenga Ogedegbe³ 

[1] Department of Psychology, Saint Johns University, 8000 Utopia Pkwy, Queens, New York, NY 11439, USA;Stritch School of Medicine, Loyola Chicago Medical Center, 2160 South 1st Avenue, Maywood, IL 60153, USA;Center for Healthful Behavior Change, Division of Health & Behavior, Department of Population Health, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA;School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Accra Road, Kumasi, Ghana

关键词: Ghana;    Community health nurses;    Community health centers;    Blood pressure control;    Task shifting;    Cluster randomized controlled trial;    Hypertension;   

Others  :  800982
DOI  :  10.1186/1748-5908-9-73

 received in 2014-05-12, accepted in 2014-06-07,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Ogedegbe et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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