Uptake of Task-Strengthening Strategy for Hypertension (TASSH) control within Community-Based Health Planning Services in Ghana: study protocol for a cluster randomized controlled trial

Abstract

Background Physician shortage is a major barrier to hypertension (HTN) control in Ghana, with only one physician to 10,000 patients in 2015, thus limiting its capacity for HTN control at the primary care level such as the Community Health Planning and Services (CHPS) compounds, where most Ghanaians receive care. A Task-Shifting Strategy for HTN control (TASSH) based on the WHO Cardiovascular (CV) Risk Package is an evidence-based strategy for mitigating provider- and systems-level barriers to optimal HTN control. Despite its effectiveness, TASSH remains untested in CHPS zones. Additionally, primary care practices in low- and middle-income countries (LMICs) lack resources and expertise needed to coordinate multilevel system changes without assistance. The proposed study will evaluate the effectiveness of practice facilitation (PF) as a quality improvement strategy for implementing TASSH within CHPS zones in Ghana. Methods Guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we will evaluate, in a hybrid clinical effectiveness-implementation design, the effect of PF on the uptake of an evidence-based TASSH, among 700 adults who present to 70 CHPS zones with uncontrolled HTN. Components of the PF strategy include (a) an advisory board that provides leadership support for implementing the intervention within the CHPS zones and (b) trained task-strengthening facilitators (TSFs) who serve as practice coaches to provide training, and performance feedback to community health officers (CHOs) who will deliver TASSH at the CHPS zones. For this purpose, the TSFs are trained to identify, counsel, and refer adults with uncontrolled HTN to community health centers in Bono East Region of Ghana. Discussion Uptake of community-based evidence-supported interventions for hypertension control in Ghana is urgently needed to address the CVD epidemic and its associated morbidity, mortality, and societal costs. Findings from this study will provide policymakers and other stakeholders the “how to do it” empirical literature on the uptake of evidence-based task-strengthening interventions for HTN control in Ghana and will serve as a model for similar action in other low, middle-income countries. Trial registration ClinicalTrials.gov, NCT03490695. Registered on 6 April 2018. Protocol version and date Version 1, date: 21 August, 2019.

Integration of a task strengthening strategy for hypertension management into HIV care in Nigeria: a cluster randomized controlled trial study protocol

“…This is the only study we are aware of that will evaluate the integration of a task-shifting strategy for hypertension control into PHCs in Lagos. The innovation of the proposed study is unlike a previous study in Ghana [ 52 ] as it will evaluate the effect of a systems-level practice facilitation strategy on hypertension control in PLWH. If successful, its findings will provide evidence for policymakers to adopt TASSH as routine practice for HIV clinics in Nigeria and similar LMICs.…”

Integration of a Task Strengthening Strategy for Hypertension Management into HIV Care in Nigeria: a Cluster Randomized Controlled Trial Study Protocol

“…This is the only study we are aware of that will evaluate the integration of a task-shifting strategy for hypertension control into PHCs in Lagos. The innovation of the proposed study is unlike a previous study in Ghana (52) as it will evaluate the effect of a systems-level practice facilitation strategy on hypertension control in PLWH. If successful, its ndings will provide evidence for policymakers to adopt TASSH as routine practice for HIV clinics in Nigeria and similar…”

Study design and protocol of a stepped wedge cluster randomized trial using a practical implementation strategy as a model for hypertension-HIV integration — the MAP-IT trial

“…The four steps are defined as follows: (1) identifying PLWH patients with uncontrolled hypertension ( BP > 140/90); (2) initiating counseling by giving clear advice on how PLWH patients can modify their behaviors; (3) treating PLWH with uncontrolled hypertension by prescribing medication treatment according to the Nigerian Simplified Hypertension Protocol; and (4) referring patients with severely elevated BP and/or a chronic comorbid condition, including established CVD, to physicians for further care. The 5 As have been implemented in previous TASSH studies [ 11 , 16 , 17 , 25 ] and applied to other health outcomes [ 33 , 34 ].…”

“…It includes both a role (practice facilitator) and a process for supporting primary care practices to build motivation and capacity at the systems and individual levels to improve organizational performance [ 19 , 21 – 24 ]. Practice facilitators (typically nurses) are trained to work with primary care practices to develop the necessary skills to adapt evidence-based strategies, e.g., task shifting/sharing, to their practice environment [ 25 ]. In this study, the practice facilitators are nurses with an average of 35 years in clinical practice.…”