PROJECT SUMMARY
Hypertension (HTN) is a leading modifiable risk factor for global cardiovascular disease and stroke morbidity
and mortality. Nigeria, Africa's most populous country, has a high HTN burden. Evidence-based interventions
(EBIs) for detection and initiation of treatment for HTN are not widely implemented in Nigeria. These EBIs
include widely available (1) BP screening (reaching all adults >18 years of age) to identify HTN early and (2)
connections to ongoing primary care for HTN management. In partnership with community and clinical
stakeholders, we are currently adapting community-based strategies shown to be effective in increasing HIV
screening and connections to care. The proposed adapted strategies – called community vital signs (CVS)
strategies – will utilize community-based screenings, digital technologies, and supportive approaches to
connect people to healthcare facilities, leveraging our practice-based research network of community clinics
within the Model Innovation Research Centers created by the Nigeria Implementation Science Alliance. We will
use the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and EPIS (Exploratory,
Preparation, Implementation, Sustainment) implementation science frameworks to guide our work. Aim 1 / R61
Phase (Year 1): Engage stakeholders to refine and finalize the co-creation of CVS strategies aiming to
increase rates of BP screening and connections to care in Nigeria. By the end of the R61 Phase, we will have
final CVS strategies and will recruit, train, and conduct implementation readiness assessments at 12
community-based sites connected with 12 healthcare facilities in 12 Nigerian cities (2 in each of Nigeria's 6
regions). R33 Phase (Years 2-5) Aim 2: Implement and assess CVS strategies aiming to increase rates of BP
screening at all 12 study sites (n=24,000 participants). We will initiate quarterly, community-based BP
screenings and evaluate using RE-AIM. Aim 3: Implement and compare 2 different CVS strategies to make
connections to primary care for those found to have high BP readings that meet HTN criteria at all study sites.
We will conduct a nested, hybrid implementation-effectiveness type III trial using a parallel 2-arm cluster
randomized design. Arm A (6 sites, n~3,000 participants): support connection to primary care by utilizing
mHealth digital technologies with bidirectional sharing of BP data between community screening site and
primary care clinic, coupled with a voucher for a medication starter kit (core strategies); Arm B (6 sites,
n~3,000 participants): Core strategies plus community health navigators making handoffs to clinic and sending
text messages (core+ strategies). This project promotes equitable access to HTN diagnosis and connections to
care, especially in cities where HTN prevalence is highest. It has the potential to significantly increase rates of
early HTN detection and prevent the morbidity and mortality associated with the downstream effect of
undiagnosed and uncontrolled HTN. It will provide evidence for scale-up of interventions to support self-
management of non-communicable chronic diseases in Nigeria and other low- and middle-income countries.
