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Identifying facilitators and barriers to heart failure care in Haiti to adapt a community-based intervention

Award Number: K23HL140133
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP
PERIOD OF PERFORMANCE START DATE: 08/01/2019
PERIOD OF PERFORMANCE END DATE: 07/31/2025

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Identifying facilitators and barriers to heart failure care in Haiti to adapt a community-based intervention - PROJEC T SUMMAR Y This proposal seeks to evaluate the biosocially complex interaction between heart failure (HF) patients and their health system to guide evidence-based interventions to improve wellbeing for patients in low- and middle- income countries (LMIC). Cardiovascular disease (CVD) causes 30% of all deaths in Haiti; nearly 4-times more deaths than human immunodeficiency virus (HIV). Our published work has shown that heart failure (HF) is the leading cause – 37% – of adult internal medicine hospitalizations. However, the crucial link from inpatient to outpatient care is not well developed as two-thirds of HF patients are not successfully linked to outpatient care, where linkage is defined as having a clinic visit within 30 days after discharge. My long-term career goal is to develop as an implementation scientist and test strategies to improve linkage to care for CVD in low-income countries. The objective of this application is to first identify barriers to poor linkage for patients hospitalized with HF in rural Haiti, and then to adapt and pilot an evidence-based CHW intervention to address the barriers based on models for HIV. My overarching hypotheses are that complex combinations of identifiable and modifiable biosocial and health system barriers influence how rural Haitian HF patients access care and that an adapted CHW intervention will enhance linkage to chronic care. The proposed research will be conducted in rural Haiti in collaboration with Partners In Health and Zanmi Lasante. Aim 1: Identify facilitators and barriers to outpatient care linkage for hospitalized HF patients. By assessing the salience of established and novel facilitators and barriers to HF care linkage from multiple perspectives, this aim will investigate what factors influence patients' decision and capacity to return for follow-up care. I will conduct a series of focus group discussions with 24-30 patients (stratified by those linked and not linked); 12-15 CHWs; and 8-12 doctors and nurses. I will identify central concepts categorized by the Consolidated Framework for Implementation Research, and also generate and refine hypotheses about facilitators and barriers to linkage. Aim 2: Adapt a CHW intervention to improve linkage to care for HF patients. By applying the findings from Aim 1 using the ADAPT-ITT framework, which has been successfully used to adapt care linkage strategies for HIV patients, I will modify an existing evidence-based CHW intervention used in HIV care for patients discharged after a HF admission based on the facilitators and barriers identified in Aim 1. Aim 3: Pilot the CHW intervention to assess feasibility and acceptability. I will pilot the adapted CHW linkage support intervention (Aim 2) with a sample of patients with HF (n=30) to improve linkage to care. I will use qualitative interviews and surveys among the patients, CHWs, doctors, nurses, and health system administrators to assess the acceptability, appropriateness, feasibility, and fidelity of the pilot intervention among all stakeholders. I will explore secondary effectiveness outcomes including linkage among the intervention group compared with a reference group of 30 HF patients.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $0 )
2025	2022	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	002	4	3/7/2025	NON-COMPETING CONTINUATION	$0
2025	2022	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	4	12/16/2024	NON-COMPETING CONTINUATION	-$84,115
2025	2022	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL	BOSTON	MA	02118	SUFFOLK	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	4	3/5/2025	NON-COMPETING CONTINUATION	$84,115
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $165,126 )
2022	2022	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL STE 1	BOSTON	MA	02118	SUFFOLK	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	4	8/26/2022	NON-COMPETING CONTINUATION	$165,126
														Subtotal = $165,126

Issue Date FY: 2021 ( Subtotal = $164,986 )
2021	2021	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CTR PL STE 1	BOSTON	MA	02118	SUFFOLK	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	3	8/13/2021	NON-COMPETING CONTINUATION	$164,986
														Subtotal = $164,986

Issue Date FY: 2020 ( Subtotal = $165,470 )
2020	2020	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CENTER PL STE 1	BOSTON	MA	02118	SUFFOLK	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	2	8/3/2020	NON-COMPETING CONTINUATION	$165,470
														Subtotal = $165,470

Issue Date FY: 2019 ( Subtotal = $167,076 )
2019	2019	BOSTON MEDICAL CENTER CORPORATION	1 BOSTON MEDICAL CENTER PL STE 1	BOSTON	MA	02118	SUFFOLK	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	1	7/31/2019	NEW	$167,076
														Subtotal = $167,076

Grand Total All Awards = $662,658

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Identifying facilitators and barriers to heart failure care in Haiti to adapt a community-based intervention

Award Number: K23HL140133

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP

PERIOD OF PERFORMANCE START DATE: 08/01/2019

PERIOD OF PERFORMANCE END DATE: 07/31/2025

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