Community Blood Pressure Groups - developing an intervention to improve blood pressure control in Zimbabwe

We aim to develop to improve blood pressure (BP) control in Zimbabwe using "Community BP Groups" (com-BP-groups) through an approach that is an effective and can be delivered at large scale. Hypertension is the leading risk factor which leads to cardiovascular outcomes such as stroke and heart disease worldwide and affects >20% adults in Zimbabwe. Most hypertension is undiagnosed, and upon diagnosis often inadequately controlled so individuals remain at risk without knowing it.

Community antiretroviral treatment (ART) groups for people living with HIV in sub-Saharan Africa help to reduce barriers for patients, with support from group members for shared repeat medication collection (reducing time and financial burden on each individual), as well as peer support for long-term continuation on treatment. Home BP measurement is increasingly used in hypertension control in the UK. Leveraging lessons learned, we will explore com-BP-groups consisting of patients with hypertension, led by 'focal' patients who are provided with low-cost validated home BP monitors to share with household members and neighbours. Individuals who meet WHO criteria for hypertension on home monitoring will be advised to link to routine clinic services and facilitated to form com-BP-groups.

We hypothesise that com-BP-groups will contribute towards better BP control by: 1) enabling self-BP measurement at home or convenient community locations, increasing detection of hypertension; 2) providing peer support for clinic attendance and improving treatment coverage; 3) improving long-term optimal BP control by enabling ongoing regular self-monitoring, improved continuation on long-term medication and group drug collection for stable patients.

Our objectives are to 1) examine how well-suited and feasible com-BP-groups are and what components are required for delivery 2) implement a preliminary version of the com-BP-group intervention for 6 months to examine how acceptable they are and what the uptake is among community members; 3) monitor the preliminary approach to examine feasibility, equity of access, barriers/enablers of delivery and unintended consequences from com-BP-group participation.

In Phase-1 we will engage stakeholders and conduct qualitative research (focus group discussions, in-depth interviews and through a "Theory of Change" workshop involving community members and those who deliver health services in the relevant communities, to gain their insights into exactly how com-BP-groups could make a difference). The information from Phase-1 will inform the detailed conduct of com-BP-groups which will be tested in Phase-2. Within the catchment area of health-facilities, com-BP-groups will be run in rural Mazowe district and Chitungwiza town. We will conduct qualitative and quantitative research to learn from the draft approach.

In Phase-3, we will evaluate how suitable and acceptable com-BP-groups are from user and provider perspectives, and how feasible it will be to implement com-BP-groups in in future. Co-production of the current study with Ministry of Health and Child Care and other partners will help ensure the long-term impact and likelihood that outputs from our research will be translated into future practice in Zimbabwe.

Our project will develop an effective and scalable intervention to improve blood pressure (BP) control in Zimbabwe using "Community BP Groups" (com-BP-groups). Leveraging lessons learned from community antiretroviral groups in sub-Saharan Africa and home BP measurement in the UK, we will explore com-BP-groups consisting of patients with hypertension, led by 'focal' patients who are provided with low-cost validated home BP monitors to share with household members and neighbours. Individuals who meet WHO criteria for hypertension on home monitoring will be advised to link to routine clinic services and facilitated to form com-BP-groups.

We hypothesise that com-BP-groups will contribute towards better BP control by: 1) enabling self-BP measurement at home or convenient community locations, increasing detection of hypertension; 2) providing peer support for clinic attendance and improving treatment coverage; 3) improving long-term optimal BP control by enabling ongoing regular self-monitoring, improved medication adherence and group drug collection for stable patients.

In Phase-1 we will engage stakeholders and conduct qualitative research (focus group discussions, in-depth interviews and through a Theory of Change workshop) to co-produce the draft intervention, which will be tested in Phase-2. Within the catchment area of health-facilities, com-BP-groups will be run in rural Mazowe district and Chitungwiza town, in a form determined during Phase-1. We will conduct qualitative and quantitative research to learn from the draft approach.

In Phase-3, we will evaluate the appropriateness and acceptability of com-BP-groups from user and provider perspectives, and feasibility of implementing com-BP-groups. We will interpret findings with partners, to define an accessible, feasible, equitable intervention for testing in a cluster randomised trial and further research on effectiveness, cost-effectiveness and sustainability.