CMIPS Seminar: Archana Shrestha "Community Health Worker-led Hypertension Control Implementation Trial in Nepal: Work in Progress"

This study aims to evaluate implementation—specifically reach, adoption, fidelity, and maintenance—and effectiveness in reducing blood pressure through implementation strategies that enhance uptake of a community-based hypertension control intervention in Nepal. The study uses a hybrid type III effectiveness–implementation trial design, with a primary focus on Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) outcomes. We conduct a cluster-randomized trial in Sindhupalchowk District, randomizing 102 health facilities into the Community-based Hypertension Prevention and Control (CHPC) intervention group (n = 52) and the standard care control group (n = 50).The CHPC intervention includes community-based blood pressure monitoring, lifestyle counseling, and medication adherence monitoring, supported by implementation strategies that include leadership support and ongoing program promotion; capacity building of healthcare workers and Female Community Health Volunteers in hypertension management; FCHV group meetings and home visits; and the creation of social networks to promote shared learning. We recruit 3,572 participants (35 per cluster) aged ≥30 years with blood pressure ≥140/90 mmHg and/or current antihypertensive medication use, and we compare outcomes between intervention and control communities.We assess implementation outcomes using mixed-methods process evaluation data from intervention health facilities, evaluate effectiveness by comparing mean systolic blood pressure reduction between groups 12 months after intervention initiation, and assess cost-effectiveness. We further examine implementation processes through observations, periodic reflections, focus group discussions, and key informant interviews, with qualitative data collection informed by the Consolidated Framework for Implementation Research and analysis conducted using rapid qualitative analytic approaches and thematic analysis. In this talk, we will present the work in progress, including study participants, intervention delivery updates, major facilitators and barriers to implementation, and lessons learned.