Participating institutions name

and acronyms

·         INCAP Research Center for the Prevention of Chronic Diseases

·         School of Public Health and Tropical Medicine, Tulane University

·         Institute for Clinical Effectiveness and Health Policy (IECS)

·         Center of Excellence for Cardiovascular Health (CESCAS)

·         Department of Family Medicine, University of Colorado

·         Ministry of Public Health and Social Assistance of Guatemala

CIIPEC Researchers

·         Manuel Ramírez-Zea

·         Diego Hernández-Galdamez

·         Ana Lucía Peralta

·         Kristyne Mansilla

·         Dina Roche

Abstract

The first phase of this project assessed the needs, barriers, and knowledge gaps of the hypertension control program in the national health care system of Guatemala.

The second phase of this project, a cluster randomized trial will test the effect of a multi-level and multi-component intervention program within the primary healthcare system in Guatemala, on blood pressure (BP) control among hypertensive patients; will evaluate the adaptability, feasibility, fidelity, and sustainability of implementing the program in the primary health care system of Guatemala; and the cost effectiveness of such program in Guatemala in comparison to usual care. The comprehensive intervention, which includes protocol-based treatment using a standard BP management algorithm, team-based collaborative care, BP audit and Feedback, home BP monitoring, and health coaching on anti-hypertensive medication adherence and lifestyle modification, will last for 18 months.

This implementation research study presents high public health impact because it will generate urgently needed data on effective, practical, and sustainable intervention strategies aimed at reducing BP related disease burden in Central America and other low-and middle-income countries.

General objective

To test whether a multilevel and multicomponent intervention program, integrated to the primary healthcare system in rural Guatemala, will improve hypertension control and lower systolic and diastolic blood pressure among patients with uncontrolled hypertension over an 18-month period compared to usual care.

Methodology

A cluster randomized trial including 36 rural health districts managed by the Ministry of Health (MOH) of Guatemala. Eighteen health districts will be assigned to a multicomponent intervention and 18 to usual care. Each health district will recruit 44 patients aged ≥40 years with uncontrolled hypertension.

Project duration

2017-2022

Publications related

Paniagua-Avila, A., Fort, M.P., Glasgow, R.E. et al. Evaluating a multicomponent program to improve hypertension control in Guatemala: study protocol for an effectiveness-implementation cluster randomized trial. Trials 21, 509 (2020). https://doi.org/10.1186/s13063-020-04345-8

Fort MP, Paniagua-Avila A, Beratarrechea A, et al. Stakeholder Engagement in the Translation of a Hypertension Control Program to Guatemala's Public Primary Health Care System: Lessons Learned, Challenges, and Opportunities. Glob Heart. 2019;14(2):155-163. doi:10.1016/j.gheart.2019.05.005

Aifah A, Iwelunmor J, Akwanalo C, et al. The Kathmandu Declaration on Global CVD/Hypertension Research and Implementation Science: A Framework to Advance Implementation Research for Cardiovascular and Other Noncommunicable Diseases in Low- and Middle-Income Countries. Glob Heart. 2019;14(2):103-107. doi:10.1016/j.gheart.2019.05.006