Evaluation of Hypertension Control Trial – Center for Health Decision Science

CHDS faculty Shafika Abrahams-Gessel and Thomas Gaziano and colleagues recently published a formative evaluation of the IMPACT-BP hypertension control trial in South Africa. In rural KwaZulu-Natal (KZN), South Africa, less than 25% of persons with hypertension have their condition under control, despite it being a significant risk factor for noncommunicable disease (NCD)-related morbidity and mortality, including heart attacks and stroke. The strategic plan of the South Africa National Department of Health is to improve health system infrastructure to allow for community-based programs that can aid in the detection, treatment and care of people with NCDs. The IMPACT-BP trial will assess the effectiveness and cost-effectiveness of a multi-pronged intervention designed to increase hypertension control. The investigators’ formative evaluation was conducted prior to the start of enrollment in the trial to assess and adapt the planned trial implementation strategy.

The evaluation identified key intervention acceptability and feasibility factors that would affect the trial implementation plan, including inadequate levels of staffing, high patient volumes, insufficient training and equipment for community health workers (CHWs), and a preference for home delivery of medications by CHWs. The study team was able to update the implementation plan by employing dedicated CHWs and nurses for trial-related activities, developing an expanded CHW training module on hypertension knowledge, teaching CHWs to measure blood pressure and to educate patients about hypertension management. Next steps are to analyze the health outcomes for the recently completed trial, conduct a cost-effectiveness analysis, and disseminate all the results to key stakeholders and policy makers in South Africa.

Learn more: Read the full formative evaluation report, A Formative Evaluation of Potential Barriers and Facilitators to Inform Effective Implementation of a Community-Based Hypertension Care Program in Rural South Africa: The IMPACT-BP Trial
Learn more: Read the IMPACT-BP randomized clinical trial protocol, Protocol: Implementation Evaluation of a Combination Intervention for Sustainable Blood Pressure Control in Rural KwaZulu-Natal, South Africa (IMPACT BP): A Three-Arm, Unblinded, Parallel Group Individually Randomized Clinical Trial