Conquering Hypertension in Urban Vietnam

PROJECT SUMMARY National data from several non-communicable diseases (NCD) risk factors surveillance surveys in Vietnam have shown disturbing increases in the prevalence of HTN between 2010 and 2020 (16% vs. 28%) in persons aged 25-64 years old. Both urban and rural populations showed significant increases in the prevalence of HTN over time in these surveys, though urban (15% to 31%) populations demonstrated greater negative trends compared to rural (16% to 27%) communities. This can be attributed to increasing adverse lifestyle practices, including unhealthy diets, physical inactivity, excessive alcohol consumption, and high levels of stress. Urban residents were more likely to have important NCD comorbidities and reported having less time to manage their HTN. The need for a large-scale and sustainable intervention approach for HTN control is emphasized in the 2022-2025 national strategic plan of Vietnam. In our recently completed NIH-funded study, we developed a multi-level, integrated approach for controlling HTN and successfully deployed it in rural northern Vietnam. Preliminary results showed that our intervention is well-accepted and effective. We now propose to adapt this work tailored to an urban Vietnamese setting using innovative implementation strategies to enhance intervention delivery (mHealth platform and Integrated Health Care Delivery System). Our intervention adaptation process will be guided by ADAPT-ITT model. Implementation and evaluation of the study will be guided by the EPIS (Exploration, Preparation, Implementation, and Sustainment) framework. The HTN-URBAN intervention includes three integrated components: (1) a storytelling intervention; (2) home BP self-monitoring; and (3) expanded community health worker services. Our specific aims for the R61 phase are to: 1) conduct an HTN Needs Assessment (30 semi-structured interviews) in Hai Phong city; 2) develop and refine HTN-URBAN based on the results of our HTN Needs Assessment and the ADAPT-ITT model for adapting a proven intervention to a new setting and condition. Our specific aims for the R33 phase are to 3) implement a cluster randomized type II Hybrid Effectiveness and Implementation trial in 14 communities in Hai Phong, including 700 patients with uncontrolled HTN, randomized to an intervention (HTN-URBAN of three integrated components) or comparison group (“Learn More” module - didactic material only without stories) to assess the primary clinical effectiveness outcome (changes in BP) and implementation outcomes including intervention acceptability, appropriateness, feasibility, adoption, and fidelity; 4) prepare for dissemination of HTN-URBAN by integration with the National Strategy on Prevention and Control for Non-Communicable Diseases and building capacity in policy-relevant Implementation Science. This project will address gaps in hypertension (HTN) control for adults living in urban setting in Vietnam by testing a multi- level, evidence-based intervention with the promise of nationwide scalability and sustainability.