Coaching and Navigation by CHWs through Telehealth for High-risk Hypertension

PROJECT SUMMARY Hypertension is the leading modifiable cardiovascular (CVD) risk factor, affecting 1 in 4 adults worldwide, of which 2/3rd live in low- and middle-income countries. Despite the availability of effective interventions, 46% of adults with hypertension are undiagnosed; and only 1 in 5 who are aware of their diagnosis are adequately managed. South Asia has one of the highest prevalence of hypertension in the world, and only less than 10% adults with hypertension achieve blood pressure control. Patients living in urban areas at particular high risk of complications of hypertension due to a variety of reasons including complex urban health system, loose social cohesion, stress and limited access to physical activity and healthy food and increased exposure to pollutants. We propose a multimodal intervention that leverages telehealth and community health workers to connect patients with severe hypertension to primary care resources and coach them using evidence-based, practical lifestyle solutions relevant to urban living. We call the intervention Coaching and Navigation by CHW through Telehealth for High-risk Hypertension or CONNECT-HTN. We have three specific aims. We will first iteratively refine and finalize the protocol for implementing the CONNECT-HTN, including establishing community and stakeholder engagement to ensure the sustainability of this approach. We will then determine whether the use of CONNECT-HTN is effective in reducing the rate of death and hospital admissions due to heart disease or stroke and compare it to referral to clinic-based care. In parallel we will evaluate the implementation of our intervention using a convergent, mixed methods study design and the Consolidated Framework for Implementation Research (CFIR). Our expectation is that CONNECT HTN will add to the evidential basis for implementing many of the WHO Best Buys for Non- Communicable Disease (NCD) prevention and control and will be the first study powered to measure substantive mortality and mortality outcomes in LMICs