Optimizing linkage and retention to hypertension care in rural Kenya (LARK hypertension study): study protocol for a randomized controlled trial.
BACKGROUND
Hypertension is the leading global risk factor for mortality. Hypertension treatment and control rates are low worldwide, and delays in seeking care are associated with increased mortality. Thus, a critical component of hypertension management is to optimize linkage and retention to care.


METHODS
This study investigates whether community health workers, equipped with a tailored behavioral communication strategy and smartphone technology, can increase linkage and retention of hypertensive individuals to a hypertension care program and significantly reduce blood pressure among them. The study will be conducted in the Kosirai and Turbo Divisions of western Kenya. An initial phase of qualitative inquiry will assess facilitators and barriers of linkage and retention to care using a modified Health Belief Model as a conceptual framework. Subsequently, we will conduct a cluster randomized controlled trial with three arms: 1) usual care (community health workers with the standard level of hypertension care training); 2) community health workers with an additional tailored behavioral communication strategy; and 3) community health workers with a tailored behavioral communication strategy who are also equipped with smartphone technology. The co-primary outcome measures are: 1) linkage to hypertension care, and 2) one-year change in systolic blood pressure among hypertensive individuals. Cost-effectiveness analysis will be conducted in terms of costs per unit decrease in blood pressure and costs per disability-adjusted life year gained.


CONCLUSIONS
This study will provide evidence regarding the effectiveness and cost-effectiveness of strategies to optimize linkage and retention to hypertension care that can be applicable to non-communicable disease management in low- and middle-income countries.


BACKGROUND
This trial is registered with (NCT01844596) on 30 April 2013.
Icahn School of Medicine at Mount Sinai, One Gustave L, Levy Place, Box 1030, 10029 New York, USA. rajesh.vedanthan@mssm.edu.
Rajesh
R
Vedanthan
Jemima H
JH
Kamano
Violet
V
Naanyu
Allison K
AK
Delong
Martin C
MC
Were
Eric A
EA
Finkelstein
Diana
D
Menya
Constantine O
CO
Akwanalo
Gerald S
GS
Bloomfield
Cynthia A
CA
Binanay
Eric J
EJ
Velazquez
Joseph W
JW
Hogan
Carol R
CR
Horowitz
Thomas S
TS
Inui
Sylvester
S
Kimaiyo
Valentin
V
Fuster
D044383:Black People / Q000523:psychology; D001794:Blood Pressure; D040421:Cell Phone; D002985:Clinical Protocols; D003142:Communication; D003153:Community Health Services / Q000191:economics; D003150:Community Health Workers / Q000191:economics; D003362:Cost-Benefit Analysis; D015438:Health Behavior; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000191:economics / Q000208:ethnology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D007630:Kenya / Q000453:epidemiology; D062405:Motivational Interviewing; D010349:Patient Compliance; D010361:Patients / Q000523:psychology*; D011369:Professional-Patient Relations; D012107:Research Design; D019035:Rural Health Services / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome