title: Outcomes and costs of implementing a community-based intervention for hypertension in an urban slum in Kenya.
abstract: OBJECTIVE
  To describe the processes, outcomes and costs of implementing a multi-component, community-based intervention for hypertension among adults aged > 35 years in a large slum in Nairobi, Kenya.
  
  
  METHODS
  The intervention in 2012-2013 was based on four components: awareness-raising; improved access to screening; standardized clinical management of hypertension; and long-term retention in care. Using multiple sources of data, including administrative records and surveys, we described the inputs and outputs of each intervention activity and estimated the outcomes of each component and the impact of the intervention. We also estimated the costs associated with implementation, using a top-down costing approach.
  
  
  RESULTS
  The intervention reached 60% of the target population (4049/6780 people), at a cost of 17 United States dollars (US$) per person screened and provided access to treatment for 68% (660/976) of people referred, at a cost of US$ 123 per person with hypertension who attended the clinic. Of the 660 people who attended the clinic, 27% (178) were retained in care, at a cost of US$ 194 per person retained; and of those patients, 33% (58/178) achieved blood pressure control. The total intervention cost per patient with blood pressure controlled was US$ 3205.
  
  
  CONCLUSIONS
  With moderate implementation costs, it was possible to achieve hypertension awareness and treatment levels comparable to those in high-income settings. However, retention in care and blood pressure control were challenges in this slum setting. For patients, the costs and lack of time or forgetfulness were barriers to retention in care.
authors.affiliation: African Population and Health Research Center, PO Box 10787-00100, Nairobi, Kenya .
authors.forename: Samuel Oji
authors.initials: SO
authors.lastname: Oti
authors.affiliation: Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands .
authors.forename: Steven
authors.initials: S
authors.lastname: van de Vijver
authors.affiliation: Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands .
authors.forename: Gabriela B
authors.initials: GB
authors.lastname: Gomez
authors.affiliation: Department of Public Health, University of Amsterdam, Amsterdam, Netherlands .
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
authors.affiliation: African Population and Health Research Center, PO Box 10787-00100, Nairobi, Kenya .
authors.forename: Thaddaeus
authors.initials: T
authors.lastname: Egondi
authors.affiliation: African Population and Health Research Center, PO Box 10787-00100, Nairobi, Kenya .
authors.forename: Catherine
authors.initials: C
authors.lastname: Kyobutungi
authors.affiliation: Department of Public Health, University of Amsterdam, Amsterdam, Netherlands .
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
mesh_terms: D000328:Adult; D000368:Aged; D001364:Awareness; D001786:Blood Glucose; D001794:Blood Pressure; D001837:Body Weights and Measures; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy*; D007630:Kenya; D008297:Male; D008875:Middle Aged; D011203:Poverty; D015397:Program Evaluation; D014505:Urban Population
chemical_list: D001786:Blood Glucose