Implementation Evaluation of a Combination Intervention for Sustainable Blood Pressure Control in Rural KwaZulu-Natal, South Africa

IMPACT-BP was an open-label, randomised controlled trial to evaluate the effectiveness of community-based, technology-supported interventions to reduce systolic blood pressure (SBP) and improve blood pressure control among individuals with uncontrolled hypertension in rural KwaZulu-Natal. The study aimed to determine whether home-based care improves outcomes over standard, clinic-based blood pressure management in rural South Africa. The study compared three treatment strategies: 1) standard of care (SOC), clinic-based management of hypertension, 2) a community blood pressure monitor-based model, in which individuals received blood pressure cuffs to measure their blood pressure at home, and were monitored by nurses via community health workers (CHW) with treatment decisions made via nurses remotely via a mobile health-based clinical decision support tool, and 3) an enhanced community blood pressure monitor-based model that included home-based blood pressure cuffs that transmitted readings over cellular networks directly to clinic-based nurses (eCHW+). In both intervention groups, CHWs visited participants to record (CHW) or verify (eCHW+) blood pressure readings, dispense medications, and relay instructions from clinic nurses.

Additional Information

LSHTM staff in contributor roles.

Keywords

Hypertension; Blood pressure control; Community-based intervention; anti-hypertensive medication; Sub-Saharan Africa; South Africa