Abstract 15333: The Addressing Hypertension Care in Africa (ADHINCRA) Study: A Multi-Level Nurse-Led, Mobile-Health Enhanced Intervention to Improve Hypertension Control in Ghana

Abstract

Background: Ghana, is experiencing silent epidemics of hypertension (HTN) and cardiovascular disease (CVD). There is a dire need to implement multilevel strategies to improve HTN control in Ghana. The Addressing Hypertension Care in Africa (ADHINCRA) Study sought to test the feasibility of a multilevel, nurse-led, mobile-health enhanced intervention to improve HTN control in Ghana. Methods: Using a cluster-randomized controlled pilot trial design, we enrolled 4 hospitals in Kumasi, Ghana and recruited 240 patients with uncontrolled HTN, defined as systolic blood pressure (BP) ≥140 mm Hg. Two hospitals were randomized to the intervention and 2 to the enhanced usual care (UC) arm. Patients in the intervention arm received nurse-led task-shifting, a mobile health application and home BP monitoring. The intervention was administered for six months, after which it was withdrawn and patients were followed for 6 more months. The enhanced UC arm received usual care, plus short text messages on health. The primary outcome was change in BP control status at 6 and 12 months. We used general linear models to examine the probability of BP control, accounting for clustering within hospitals. Results: The mean age was 53 ± 9.7 years, 51% were women. After 6 months, BP control improved in the intervention arm (57.0%, 95% CI 56.8% to 57.1%) versus 18.1%, 95% CI 16.9% to 19.3%, for the UC arm), with a between-group difference of 38.9% (95% CI 37.7% to 40.1%; p<0.001). After 12 months, BP control improved in the intervention arm (80.5%, 95% CI 65.5% to 95.4%) versus 24.2%, 95% CI 10% to 38.5%, for the UC arm), with a between-group difference of 56.2% (95% CI 35.6% to 76.8%; p<0.001). ( Figure) Conclusion: A multi-level intervention nurse-led, mobile-health enhanced intervention was associated with greater BP control than enhanced UC among patients with HTN in Ghana. A larger scale study is warranted to support future scale-up of the ADHINCRA Study.