The U01/LARK Study grant is a five-year grant (1st April, 2012 to 31st March, 2017) awarded by NHLBI, aiming at optimizing linkage and retention of hypertension patients to care in Western Kenya. This grant was aimed at ascertaining the causes of non-linkage and non-retention, and develops solutions that will optimize linkage and retention to care within the study communities. Hypertension awareness, treatment, and control rates are low in most regions of the world. 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 Academic Model Providing Access to Healthcare (AMPATH) Partnership 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. To address this challenge, we propose to develop and evaluate innovative community-based strategies and initiatives supported by mobile technology.
• Aim 1: 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: 1) baraza (traditional community gathering) form of inquiry; 2) focus group discussions among individuals with elevated blood pressure during home-based testing; and 3) focus group discussions among CHWs.
• Subsidiary Aim 1.1: Using identified facilitators and barriers, develop a tailored behavioral communication strategy guided by the Health Belief Model modified by incorporating emotional elements for the CHWs to use with hypertensive patients, focusing on regular and timely attendance at hypertension clinic. We will test the communication strategy for face and content validity using focus group discussions with CHWs and individuals with elevated blood pressure.
• Subsidiary Aim 1.2: 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 using think-aloud technique, mock patient encounters, focus group discussions, and participant observation.
• Aim 2: 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:
1) usual care (CHWs with standard training on recruitment of individuals with any chronic condition)
2) CHWs with an additional tailored behavioral communication strategy
3) CHWs with a tailored behavioral communication strategy an also equipped with smartphone-based tool linked to the AMRS. The co-primary outcome measures will be: 1) documented linkage to care following home-based testing, and 2) one year change in systolic blood pressure among hypertensive individuals.
3) Evaluate the incremental cost-effectiveness of each intervention arm of the cluster randomized trial.
Chronic Disease Management (CDM)
This project, entitled ‘Empowering Frontline Health Workers (FLHWs) for Non-Communicable Disease Management’ aimed to use mobile smartphone-based technologies to improve the provision of chronic disease care within communities in Western Kenya. The program’s initial focus was on hypertension, diabetes and rheumatic heart disease, and care provision was by front line health workers including community health volunteers, community health extension workers, and dispensary nurses.
The main outcomes of the project included:
1) Developing and implementing a secure, smartphone-based mobile platform for non-communicable diseases (NCDs), focusing initially on hypertension and diabetes.
2) Implementing this platform for use by Frontline Health Workers within the catchment area served by the Academic Model Providing Access to HealthCare (AMPATH) in Western Kenya.
3) Using the mobile technology for screening visits for hypertension and diabetes, prevention training, targeted revisits based on reminders and consultation services for hypertension and diabetes.
The ultimate goals of this project included:
– Improved compliance with care guidelines for diabetes and hypertension through use of reminders and alerts
– Improved knowledge by FLHWs of the appropriate standards of care for diabetes and hypertension
– Health system strengthening through improved monitoring of FLHW work performance
Specific Aims: Bridging Income Generation with Group Integrated Care (BIGPIC) Over 80% of cardiovascular disease (CVD) deaths occur in low- and middle-income countries (LMICs). Diabetes, a major risk factor for CVD, is also responsible for substantial morbidity and mortality in LMICs. Elevated blood pressure (BP) increases CVD risk among individuals with diabetes and pre-diabetes; BP control is therefore a powerful way to reduce CVD risk. Cost-effective, culturally appropriate, and context-specific approaches are critical. Two promising strategies to improve health outcomes are group medical visits and micro finance. Both can increase quality of care, clinician-patient trust, self-efficacy, health savings, self-confidence, group cohesion, and social support. While these strategies have been successful in other contexts, their impact on CVD risk reduction among diabetics and pre-diabetics in low-resource settings is not known.