title: A community-driven hypertension treatment group in rural Honduras.
abstract: BACKGROUND
  We formed a self-funded hypertension treatment group in a resource-poor community in rural Honduras. After training community health workers and creating protocols for standardized treatment, we used group membership fees to maintain the group, purchase generic medications in bulk on the local market, and hire a physician to manage treatment. We then assessed whether participation in the group improved treatment, medication adherence, and hypertension control.
  
  
  METHODS
  This is a program evaluation using quasi-experimental design and no control group. Using data from the 86 members of the hypertension treatment group, we analyzed baseline and follow-up surveys of members, along with 30 months of clinical records of treatment, medication adherence, and blood pressure readings.
  
  
  RESULTS
  Our initial hypertension needs assessment revealed that at baseline, community hypertensives relied on the local Ministry of Health clinic as their source of anti-hypertensive medications and reported that irregular supply interfered with medication adherence. At baseline, hypertension group members were mainly female, overweight or obese, physically active, non-smoking, and non-drinking. After 30 months of managing the treatment group, we found a significant increase in medication adherence, from 54.8 to 76.2% (p<0.01), and hypertension control (<140/90 mmHg), from 31.4 to 54.7% (p<0.01). We also found a mean monthly decrease of 0.39 mmHg in systolic blood pressure (p<0.01). At the end of the 30-month observation period, the local Ministry of Health system had increased provision of low-cost anti-hypertensive medications and adopted the hypertension treatment group's treatment protocols.
  
  
  CONCLUSIONS
  Formation of a self-funded, community-based hypertension treatment group in a rural, resource-poor community is feasible, and group participation may improve treatment, medication adherence, and hypertension control and can serve as a political driver for improving hypertension treatment services provided by the public system.
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.|Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.|Salud Juntos, Seattle, WA, USA; sreiger@partners.org.
authors.forename: Sheridan
authors.initials: S
authors.lastname: Reiger
authors.affiliation: Health Promotion Research Center, Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Harris
authors.affiliation: Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Kwun Chuen Gary
authors.initials: KC
authors.lastname: Chan
authors.affiliation: Departmento de Yoro, Morazán, Hector Lopez Oqueli, Secretaría de Salud, Yoro, Honduras.
authors.forename: Hector Lopez
authors.initials: HL
authors.lastname: Oqueli
authors.affiliation: Health Promotion Research Center, Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Marlana
authors.initials: M
authors.lastname: Kohn
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D003150:Community Health Workers; D005260:Female; D006721:Honduras; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015397:Program Evaluation; D019035:Rural Health Services
chemical_list: D000959:Antihypertensive Agents
keywords: community health workers; generic anti-hypertensives; global health; group-based treatment; program evaluations