Transforming Hypertension Treatment in Nigeria Using a Type II Hybrid, Interrupted Time Series Design

Conditions

Hypertension

Keywords

Hypertension, Nigeria, Primary Health Center

Brief summary

The purpose of the Transforming Hypertension Treatment in Nigeria Program is to improve awareness, treatment, and control of hypertension in Nigeria through the adaptation, implementation, and evaluation of the effectiveness and implementation of a system-level hypertension control program.

Detailed description

This study includes the implementation and evaluation of a culturally- and contextually-adapted intervention package based on the Kaiser Permanente Northern California and World Health Organization HEARTS programs for hypertension diagnosis and treatment at primary health centers in Abuja, Nigeria. The intervention has been adapted based on a local needs' assessment including evidence synthesis and specific exploration of health care workers' knowledge, attitudes, and behaviors related to hypertension, causes, consequences, and treatment, including fixed-dose combination and patient self-management, and patients' knowledge, attitudes, and behaviors related to hypertension, causes, consequences, and treatment. Implementation pathways have been developed with particular attention to overcoming modifiable system- and patient-level barriers to hypertension treatment and control across capability, intentional, and system domains using the Consolidated Framework for Implementation Research. Preparedness and capacity have been assessed at primary health centers (e.g. available staff; information systems; use of clinical guidelines) through an adapted Service Availability and Readiness Assessment (SARA) instrument during the formative work for this study. The multi-level implementation package includes: 1) patient registration and empanelment (health system level), 2) standard treatment protocol (national policy level), 3) encouragement of fixed-dose combination therapy (health system level), 4) team-based care (health worker level), and 5) home blood pressure monitoring and health coaching (patient-level).

Ye J, Hirschhorn LR, Baldridge AS, Jamro EL, Orji IA, Shedul GL, Ripiye NR, Ojo TM, Eze H, Shedul GJ, Ugwuneji EN, Okoli RCB, Ale BM, Osagie S, Sanuade OA, Iyer G, Kandula NR, Ojji DB, Huffman MD.

2025-11-26

10.1186/s13012-025-01472-1

Implementation of the Extension for Community Healthcare Outcomes Model for Hypertension Education of Frontline Health Care Workers in the Federal Capital Territory, Nigeria: Explanatory Sequential Mixed Methods Evaluation

Abigail S. Baldridge, Adaora Odukwe, Olabisi Dabiri, L Nneka Mobisson, Maria Moosa Munnee et al. (16 authors)

Journal of Medical Internet Research2025-04-24

10.2196/66351

Supportive supervision visits in a large community hypertension programme in Nigeria: implementation methods and outcomes

Gabriel Shedul, Nanna Ripiye, Erica L Jamro, Ikechukwu A. Orji, Grace Shedul et al. (14 authors)

BMJ Open Quality2025-01-015 citations

10.1136/bmjoq-2024-003163

Enhancing hypertension education of community health extension workers in Nigeria’s federal capital territory: the impact of the extension for community healthcare outcomes model on primary care, a quasi-experimental study

Abigail S. Baldridge, Ikechukwu A. Orji, Gabriel Shedul, G. Y. N. Iyer, Erica L Jamro et al. (16 authors)

BMC Primary Care2024-09-077 citations

10.1186/s12875-024-02579-y

Nigeria healthcare worker SARS-CoV-2 serology study: Results from a prospective, longitudinal cohort

Dike Ojji, Amelia Sancilio, Gabriel Shedul, Ikechukwu A. Orji, Aashima Chopra et al. (20 authors)

PLOS Global Public Health2023-01-173 citations

10.1371/journal.pgph.0000549

Hypertension Treatment in Nigeria (HTN) Program: rationale and design for a type 2 hybrid, effectiveness, and implementation interrupted time series trial.

Baldridge AS, Aluka-Omitiran K, Orji IA, Shedul GL, Ojo TM, Eze H, Shedul G, Ugwuneji EN, Egenti NB, Okoli RCB, Ale BM, Nwankwo A, Osagie S, Ye J, Chopra A, Sanuade OA, Tripathi P, Kandula NR, Hirschhorn LR, Huffman MD, Ojji DB.

2022-08-0229 citations

10.1186/s43058-022-00328-9

Interventions

OTHEREvidence-based fixed-dose combination protocol based treatment

The intervention has been adapted based on a local needs' assessment including exploration of health care workers and patient's knowledge, attitudes, and behaviors related to HTN, causes, consequences, and treatment. Implementation pathways have been developed with particular attention to overcoming modifiable barriers to HTN treatment and control across capability, intentional, and system domains using CFIR. Sites will randomly be assigned to receive either: Step 1 amlodipine 5mg; Step 2 amlodipine 5 mg + losartan 50 mg (as 2 separate pills); Step 3 amlodipine 10 mg + losartan 100 mg (as 4 separate pills); Step 4 amlodipine 10/losartan 100/HCTZ 25 (as 2 single pill combo) or Step 1 amlodipine 5mg; Step 2 amlodipine 5 mg + losartan 50 mg (as 1 single pill combo); Step 3 amlodipine 10 mg + losartan 100 mg (as 2 single pill combo); Step 4 amlodipine 10/losartan 100/HCTZ 25 (as 2 single pill combo).

Study design

Allocation

NA

Intervention model

SINGLE_GROUP

Primary purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Intervention model description

This study applies an interrupted time series design.

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

No

Inclusion criteria

* Adults (≥18 years). * Elevated blood pressure (Systolic Blood Pressure ≥ 130 mmHg or Diastolic Blood Pressure ≥ 80 mmHg) documented or measured by a health care professional (e.g., physician, Community Health Extension Worker, or Community Health Officer).

Exclusion criteria

* Individuals who are not yet adults (minors) * Prisoners or other detained individuals.

Design outcomes

Primary

Measure	Time frame	Description
Change from Baseline Slope of Treatment Rate	Through study completion, 45 months	Hypertension treatment using any blood pressure lowering drug. Treatments rates are calculated monthly, over 9 months of baseline and 39 months of intervention.
Change from Baseline Slope of Control Rate	Through study completion, 45 months	Hypertension control is defined as a Systolic Blood Pressure \<140 mmHg and Diastolic Blood Pressure \<90 mmHg. Control rates are calculated monthly, over 9 months of baseline and 39 months of intervention.

Countries

Nigeria

Outcome results

None listed