Hypertension Treatment in Nigeria Program

University Of Abuja, Abuja

Investigators

Linked publications & trials

Abstract

PROJECT ABSTRACT This renewal application (R01HL144708) seeks to evaluate and expand upon the successful research conducted during the initial funding period to address the public health impact of hypertension and diabetes in Nigeria. Following a formative research period and based on the WHO ExpandNet framework, we propose to evaluate the effectiveness and implementation of scaling up of the HEARTS multilevel bundle in improving hypertension control in 50 new primary healthcare centers across five states using a type II hybrid study design. We will also evaluate the effect of diabetes service integration through the HEARTS-D bundle on diabetes control and process of implementation into 10 previously enrolled primary healthcare centers in the Federal Capital Territory. The study will explore the sustainment of hypertension services in primary healthcare centers that participated in the initial funding period in the Federal Capital Territory using the DHIS-2 health management information system platform. During the initial funding period, we achieved significant milestones, including: 1) exceeding our recruitment targets, 2) implementing a supportive supervision program and drug revolving fund alongside HEARTS, 3) achieving and sustaining hypertension control rates of >50% for nearly two years, and 4) demonstrating normalization into routine care and high measures of sustainability. The program has become one of the largest hypertension control initiatives in Africa, with impressive results and rigorous assessment methods leading to >10 publications. Through the proposed renewal, we will expand our efforts to Nigeria’s five other geopolitical zones, thus conducting the largest assessment of hypertension care scale-up in Africa. The integration of diabetes services into primary care settings is also a critical focus, given the growing burden of diabetes in Nigeria. We have established, strong collaborations with national, state, and local stakeholders, including government health agencies, policymakers, and healthcare providers. We use contemporary dissemination and implementation science methods, including the WHO ExpandNet framework for scale-up, the Implementation Research Logic Model to assess implementation outcomes, including cost, Normalization Measure Development (NoMAD) to assess normalization into routine care, and the Program Sustainability Assessment Tool (PSAT) to evaluate sustainability beyond the funding period. The renewal period offers an opportunity to advance the field of cardiovascular dissemination and implementation science, while contributing to the knowledge of effective management of non-communicable diseases in primary care settings in a middle-income country setting. This high-impact research has a high likelihood of driving sustained change to improve health outcomes in Nigeria and beyond and is aligned with NHLBI strategic priorities. The University of Abuja will also serve as the primary institution for the renewal, ensuring the program's sustainability beyond the funding period.