Addressing gaps in hypertension care and control in Medellin, Colombia: formative research, multi component quasi-experimental intervention

Uncontrolled hypertension is a key factor in the rising epidemic of cardiovascular diseases (CVD), especially in low and middle income countries (LMIC). In Colombia, 30% of all deaths and 16% of Years of Life Lost can be attributed to CVD. Nevertheless, research on the main gaps in hypertension care and control and studies evaluating health services interventions to improve hypertension care in LMIC remain scarce. Notwithstanding, the US Centers for Disease control and Prevention and the Pan American Health Organization recently developed the Standardized Hypertension Treatment and Prevention (SHTP) Project, which provides a practical approach to improve CVD prevention and management using hypertension as the entry point. Our main objectives are: to determine the prevalence of hypertension among the population aged 35 years or older in two low-income urban Communes of Medellin city, Colombia; to estimate the magnitude and the determinants of the main gaps in hypertension care and control (access to health services, diagnosis, treatment, follow-up); and to design, implement and evaluate a multicomponent intervention for improving hypertension care and control at population level. The baseline study aims at generating knowledge on the magnitude of key gaps in hypertension care and control at the population level, on their determinants and on out-of-pocket expenditures for hypertension care. A population-based cross-sectional survey will be performed in people 35 years or older living in the study Communes. Based on the technical recommendations contained in the SHTP Project, on the results of the baseline study, on the context and in consultation with the local partners (Metrosalud and the University of Antioquia), a multi-component intervention for the improvement of hypertension care and control will be designed, implemented and evaluated. The components of the intervention aim to integrate activities related to: A) Health services organization, B) Training of clinical staff and C) Patients and community engagement. A quasi-experimental, controlled before-after trial will be carried-out. The main outcomes will be assessed with difference in difference measures (post-pre changes in the intervention minus post-pre changes in the control commune). The implementation process will be studied and evaluated with mixed methods; and we will also monitor and document fidelity of the implementation and the external events that might bear on the outcomes. This PhD research will provide new evidence regarding the magnitude and the determinants of the main gaps in hypertension care in Colombia and on the effectiveness of a multi-component intervention for improving hypertension care and control at the population level. Findings are expected to contribute to improving the health care provision model of Metrosalud (an important public network of health services in Medellin city) and to be considered for generalization in the entire country.

Keywords:B680-public-health

Project type:PhD project