Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study

Abstract

ObjectivesTo evaluate the effectiveness of the Community-based Hypertension Improvement Project (ComHIP) in increasing hypertension control.SettingLower Manya Krobo, Eastern Region, Ghana.ParticipantsAll adult hypertensive community members, except pregnant women, were eligible for inclusion in the study. We enrolled 1339 participants, 69% of whom were female. A total of 552 had a 6-month visit, and 338 had a 12-month visit.InterventionsWe report on a package of interventions where community-based cardiovascular disease (CVD) nurses were trained by FHI 360. CVD nurses confirmed diagnoses of known hypertensives and newly screened individuals. Participants were treated according to the clinical guidelines established through the project’s Technical Steering Committee. Patients received three types of reminder and adherence messages. We used CommCare, a cloud-based system, as a case management and referral tool.Primary outcomeHypertension control defined as blood pressure (BP) under 140/90 mm Hg. Secondary outcomes: changes in BP and knowledge of risk factors for hypertension.ResultsAfter 1 year of intervention, 72% (95% CI: 67% to 77%) of participants had their hypertension under control. Systolic BP was reduced by 12.2 mm Hg (95% CI: 14.4 to 10.1) and diastolic BP by 7.5 mm Hg (95% CI: 9.9 to 6.1). Due to low retention, we were unable to look at knowledge of risk factors. Factors associated with remaining in the programme for 12 months included education, older age, hypertension under control at enrolment and enrolment date. The majority of patients who remained in the programme were on treatment, with two-thirds taking at least two medications.ConclusionsPatients retained in ComHIP had increased BP control. However, high loss to follow-up limits potential public health impact of these types of programmes. To minimise the impact of externalities, programmes should include standard procedures and backup systems to maximise the possibility that patients stay in the programme.

Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis

“…Health workers in Ghana have identified barriers relating to health professionals, health system and patients which hinder adequate control of hypertension [ 151 ]. Some of these barriers could be addressed through better community engagement and the implementation of nurse-led interventions in task-shifting programmes [ 152 , 153 ].…”

Cost-effectiveness of a Community-based Hypertension Improvement Project (ComHIP) in Ghana: results from a modelling study

“…A total of 1339 individuals were enrolled in the programme by December 2016. 15 A full list of ComHIP activities can be found in online supplemental tables S1 and S2 in the supporting information file. For more details about the ComHIP implementation see Adler et al .…”

“…For more details about the ComHIP implementation see Adler et al . 15 ComHIP was independently evaluated by the Ghana School of Public Health and the London School of Hygiene and Tropical Medicine—the evaluation included several substudies. The main study was a cohort study of hypertensive individuals enrolled in ComHIP in the intervention district.…”

Barriers and facilitators to the implementation of a community-based hypertension improvement project in Ghana: a qualitative study of ComHIP

“…Other programmes in sub-Saharan Africa have found at least limited success in the implementation of training nurses in the management of hypertension (for example in DRC [20]; in Nigeria [21]; in Kenya [22]; and Ghana [23]). Quantitative results show that while ComHIP succeeded in managing hypertension in patients who remained in the programme, there was a high loss to follow up [24]. Our qualitative analysis shows that had a positive response to the programme, suggesting that reasons other than its acceptability were the cause for this.…”