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Implementation of a Combination Intervention for Sustainable Blood Pressure Control in Rural KwaZulu-Natal, South Africa (IMPACT-BP)

Award Number: R01HL144848
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/04/2020
PERIOD OF PERFORMANCE END DATE: 08/31/2025

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Implementation of a Combination Intervention for Sustainable Blood Pressure Control in Rural KwaZulu-Natal, South Africa (IMPACT-BP) - ABSTRACT Uncontrolled hypertension is the primary risk factor for stroke and hypertensive heart disease, which are the leading causes of NCD deaths in South Africa, and of disability adjusted-life years lost globally. Clinical trials have demonstrated sizeable reductions in morbidity and mortality with modest reductions in blood pressure. Yet, there is a large knowledge-implementation gap between efficacy literature on hypertension control and effectiveness of health systems to provide hypertension care. This is particularly true in resource- limited settings, where the constrained public health infrastructure will require innovative scalable and cost- effective interventions. In South Africa, 25% of the population over 15 years have elevated blood pressure, yet only 33% of those with hypertension are on treatment. In rural KwaZulu-Natal, we recently found that 16% of adults > 18 years old have hypertension, and fewer than 25% of them are controlled. The scientific goals of this project are to inform best practices for implementation of interventions to promote hypertension care in rural sub-Saharan Africa. We have undertaken mixed-methods formative work to identify significant structural barriers to engagement in hypertension care. Qualitative interviews with patients and healthcare professionals also revealed that lack of patient self-efficacy, structural barriers, and nursing training deficiencies were additional health systems barriers. Finally, we reviewed best practices for hypertension care and engaged local stakeholders to propose a package of interventions relevant to the rural South African setting, and potentially applicable to other low-medium resource settings. We will conduct an implementation evaluation of a two-level intervention package: 1) an enhanced clinic-level intervention, through stepped-wedge cluster randomization, and 2) an individually randomized home blood pressure monitoring system to promote self-efficacy. We will evaluate the implementation using the Consolidated Framework for Implementation Research and the Proctor Implementation outcomes framework, with a focus on Acceptability & Fidelity (Aim 1), Effectiveness (Aim 2) and Cost-effectiveness and Sustainability (Aim 3). To do so, we will leverage a multidisciplinary team of experts, and an externally-funded hypertension screening and referral program for 30,000 individuals in the catchment area during 2018-2019. This proposal is responsive to multiple priorities stated in PAR-18-007, including 1) implementation of evidence-based practices within clinical settings, 2) partnership with existing care systems, 3) longitudinal observation to assess sustainability, and 4) focus on reduction of health disparities. Perhaps most importantly, due to our partnership with the Department of Health, we are well-poised to advance the implementation science to elucidate best practices for hypertension care in resource-limited settings, with global implications. !


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	2024	AFRICA HEALTH RESEARCH INSTITUTE	719 UMBILO RD	DURBAN				ZAF	Cardiovascular Diseases Research	001	5	8/29/2025	NON-COMPETING CONTINUATION	$0
2025	2023	AFRICA HEALTH RESEARCH INSTITUTE	719 UMBILO RD	DURBAN				ZAF	Cardiovascular Diseases Research	000	4	1/15/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = $572,149 )
2024	2024	AFRICA HEALTH RESEARCH INSTITUTE	719 UMBILO RD	DURBAN				ZAF	Cardiovascular Diseases Research	000	5	8/15/2024	NON-COMPETING CONTINUATION	$572,149
														Subtotal = $572,149

Issue Date FY: 2023 ( Subtotal = $554,024 )
2023	2023	AFRICA HEALTH RESEARCH INSTITUTE	719 UMBILO RD	DURBAN				ZAF	Cardiovascular Diseases Research	001	4	8/11/2023	NON-COMPETING CONTINUATION	$554,024
2023	2022	KWAZULU NATAL RESEARCH INSTITUTE FOR TUBERCULOSIS AND HIV (K-RITH)	UKZN UMBILO ROAD	DURBAN				ZAF	Cardiovascular Diseases Research	000	3	10/29/2022	NON-COMPETING CONTINUATION	$0
2023	2022	AFRICA HEALTH RESEARCH INSTITUTE	719 UMBILO RD	DURBAN				ZAF	Cardiovascular Diseases Research	002	3	8/31/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $554,024

Issue Date FY: 2022 ( Subtotal = $597,178 )
2022	2022	KWAZULU NATAL RESEARCH INSTITUTE FOR TUBERCULOSIS AND HIV (K-RITH)	UKZN UMBILO ROAD	DURBAN				ZAF	Cardiovascular Diseases Research	000	3	8/22/2022	NON-COMPETING CONTINUATION	$597,178
														Subtotal = $597,178

Issue Date FY: 2021 ( Subtotal = $576,285 )
2021	2021	KWAZULU NATAL RESEARCH INSTITUTE FOR TUBERCULOSIS AND HIV (K-RITH)	UKZN UMBILO ROAD	DURBAN				ZAF	Cardiovascular Diseases Research	000	2	9/1/2021	NON-COMPETING CONTINUATION	$576,285
														Subtotal = $576,285

Issue Date FY: 2020 ( Subtotal = $605,177 )
2020	2020	KWAZULU NATAL RESEARCH INSTITUTE FOR TUBERCULOSIS AND HIV (K-RITH)	UKZN UMBILO ROAD	DURBAN		4001		ZAF	Cardiovascular Diseases Research	000	1	9/4/2020	NEW	$605,177
														Subtotal = $605,177

Grand Total All Awards = $2,904,813

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Implementation of a Combination Intervention for Sustainable Blood Pressure Control in Rural KwaZulu-Natal, South Africa (IMPACT-BP)

Award Number: R01HL144848

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/04/2020

PERIOD OF PERFORMANCE END DATE: 08/31/2025

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