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Uptake of Task shifting strategy for blood pressure control in Community health planning services: A mixed method study

Award Number: U01HL138638
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: COOPERATIVE AGREEMENT
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY / ABSTRACT This proposal is between the Kwame Nkrumah University of Science and Technology, Kintampo Health Research Center in Ghana and NYU School of Medicine. 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. Task shifting of primary care duties from physicians to non-physician health workers is a cost-effective strategy for mitigating this problem. In a cluster RCT in 32 health centers in Ghana, we showed that a Task-Shifting Strategy for HTN Control (TASSH) based on the WHO Cardiovascular (CV) Risk Package, delivered by community health nurses (CHNs), led to 34% greater reduction in systolic BP than health insurance coverage among 757 patients. TASSH comprised: 1) CV risk assessment; 2) patient counseling on lifestyle modification, and 3) initiation of antihypertensive medications. Despite its effectiveness, implementation of TASSH across CHPS compounds remains untested because of lack of resources in Ghana. A well-proven strategy to overcome this barrier is practice facilitation (PF) via provision of external expertise on practice redesign, and a tailored approach to implementing guideline-concordant care. CHPS compounds are unique settings to implement TASSH because in CHPS Community Health Officers (CHOs) deliver primary care services. Guided by Consolidated Framework for Implementation Research and the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework, we will evaluate, in a hybrid clinical effectiveness-implementation design, the role of PF on the uptake of TASSH in 70 CHPS compounds. The proposed PF strategy will include a) an advisory board that will provide leadership support for implementing TASSH; and b) trained Practice Outreach Facilitators (CHNs) who will serve as practice coaches and provide support, knowledge exchange and performance feedback to the CHOs who will deliver TASSH at the CHPS compounds. The specific aims are to: (1) Identify practice capacity for the adoption of TASSH at CHPS compounds and develop a culturally tailored PF strategy using qualitative methods; (2a) Evaluate in a stepped- wedge cluster RCT, the effect of PF vs. Usual Care (UC), on the uptake of TASSH (primary outcome) across the CHPS compounds at 12 months;(2b) Compare in a stepped-wedge cluster RCT, the clinical effectiveness of PF vs. UC on systolic BP reduction (secondary outcome) among adults with uncontrolled HTN at 12 months; (3) Evaluate the mediators (implementation climate, leadership support, organizational capacity and provider- level characteristics) of the uptake of TASSH across the CHPS compounds at 12 months; and (4) Evaluate the sustainability of TASSH implementation across the CHPS compounds at 24 months (one year after completion of the trial). Outcomes will be measured at 12 and 24 months in all clusters.


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: 2023 ( Subtotal = $0 )
2023	2021	KINTAMPO HEALTH RESEARCH CENT ER	RESEARCH STR	KINTAMPO				GHA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	5	7/14/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2021 ( Subtotal = $548,194 )
2021	2021	KINTAMPO HEALTH RESEARCH CENT ER	RESEARCH STR	KINTAMPO				GHA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	5	7/22/2021	NON-COMPETING CONTINUATION	$548,194
2021	2019	KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY	KNUST CAMPUS	KUMASI				GHA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	3	2/6/2021	NON-COMPETING CONTINUATION	$0
														Subtotal = $548,194

Issue Date FY: 2020 ( Subtotal = $553,910 )
2020	2020	KINTAMPO HEALTH RESEARCH CENT ER	RESEARCH STR	KINTAMPO				GHA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	002	4	9/4/2020	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$553,910
2020	2019	KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY	KNUST CAMPUS	KUMASI		0000		GHA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	3	9/3/2020	NON-COMPETING CONTINUATION	$0
2020	2019	KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOG	KNUST CAMPUS	KUMASI				GHA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	3	1/25/2020	NON-COMPETING CONTINUATION	$0
														Subtotal = $553,910

Issue Date FY: 2019 ( Subtotal = $563,815 )
2019	2019	KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOG	KNUST CAMPUS	KUMASI				GHA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	3	5/16/2019	NON-COMPETING CONTINUATION	$563,815
														Subtotal = $563,815

Issue Date FY: 2018 ( Subtotal = $564,616 )
2018	2018	KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOG	KNUST CAMPUS	KUMASI				GHA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	2	8/8/2018	NON-COMPETING CONTINUATION	$0
2018	2018	KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOG	KNUST CAMPUS	KUMASI				GHA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	002	2	9/8/2018	SUPPLEMENT FOR EXPANSION	$281,800
2018	2018	KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOG	KNUST CAMPUS	KUMASI				GHA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	2	6/11/2018	NON-COMPETING CONTINUATION	$282,816
														Subtotal = $564,616

Issue Date FY: 2017 ( Subtotal = $289,980 )
2017	2017	KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOG	KNUST CAMPUS	KUMASI				GHA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	1	9/1/2017	NEW	$289,980
														Subtotal = $289,980

Grand Total All Awards = $2,520,515

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Uptake of Task shifting strategy for blood pressure control in Community health planning services: A mixed method study

Award Number: U01HL138638

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: COOPERATIVE AGREEMENT

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

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