Detection, Linkage To Care, Treatment And Monitoring Of Hypertension In Coastal Communities In Accra, Ghana: Protocol For A Quasi-Experimental Study (The Ghana Heart Initiative Hypertension Study).

Abstract

Introduction Over the past few decades, the prevalence of hypertension in Ghana has increased significantly. Insufficient diagnosis and suboptimal management of diagnosed cases result in increased mortality and morbidity due to poor blood pressure control and attendant complications. This highlights the need for new models of hypertension control in highly burdened, urban poor communities. This study aims to identify patients with hypertension in the coastal communities of the Greater Accra region, link patients newly diagnosed with hypertension to appropriate medical care and monitor treatment outcomes using task-shifting strategies. Methods and analysis In this quasi-experimental study, participants with a mean blood pressure of ≥140/90mm Hg will be recruited from seven coastal communities of Ghana’s Greater Accra region. Based on proportion to the size of these communities, we will screen and recruit 10 000 and 3000 participants, respectively, from all study sites. We will link the recruited individuals to designated health facilities and follow them for a year to assess treatment outcomes, blood pressure control, adherence to treatment, anthropometric measurements, funduscopic assessment, urinalysis, blood urea nitrogen and creatinine level, ECG and echocardiograms. In addition, we will use mobile health technology to support community screening, blood pressure checks and remote monitoring of patients diagnosed with hypertension, as well as send messages on medication adherence and lifestyle changes. Furthermore, we will conduct focus group discussions among community members and indepth interviews with persons considered to be newly diagnosed with hypertension, community health workers and religious leaders/representatives to assess the knowledge and perceptions of different study participants regarding hypertension diagnosis, management, control, experiences and treatment. Ethics and dissemination The study was approved by the Ghana Health Service Ethics Review Committee (protocol identification number GHS-ERC 028/08/22). We will obtain written informed consent from each participant. In addition to journal publication, dissemination activities will include a report to the Ghana Health Service on the outcome of the project. The key strength of this study is its use of task shifting with community healthcare providers and of electronic blood pressure monitoring that is based on existing national electronic platforms, an ap proach that aims to make healthcare easily acces sible to patients while ensuring good blood pressure control. ⇒ The study will gather data to determine the feasibil ity and cost-effectiveness of this approach in treat ing high blood pressure in coastal areas where it is prevalent. ⇒ The results of this study will guide the development of the first ever electronic platform for community healthcare workers for collecting clinical data which doctors can evaluate in clinics, potentially improving communication between doctors and community healthcare providers in Ghana. ⇒ The study may result in a low number of recorded consultations during the evaluation phase due to unreliable internet connectivity and power supply issues, limiting the conclusions that can be drawn.