Nurse Management of Hypertension in Rural Western Kenya Cardiovascular disease (CVD) is the leading cause of death in sub-Saharan Africa among adults above age 30. The prevalence of hypertension, a major risk factor for CVD, is increasing over time in sub-Saharan Africa, exerting a significant epidemiologic and economic burden on the region. Without adequate control of hypertension, its health and economic burden will increase drastically in the decades ahead. Well established and evidence-based interventions to manage hypertension exist. However, treatment and control rates are low, due to several reasons including lack of an effective chronic disease management platform, inadequate access to essential medicines, and insufficient human resources. One strategy to improve delivery of hypertension care is task-shifting, in which specific tasks are """"""""shifted"""""""" from highly qualified health workers to health workers with shorter training and fewer qualifications. Thus, the overall objective of this project is to utilize a multi- disciplinary implementation research approach to optimize delivery of hypertension care in sub-Saharan Africa, focusing on a task-shifting strategy involving nurse management of hypertension. The candidate, Dr. Rajesh Vedanthan, Assistant Professor of Medicine/Cardiology at Mount Sinai School of Medicine, aims to become an independent clinical investigator specializing in implementation research, in order to optimize the delivery of cardiovascular prevention and treatment interventions in low- and middle-income countries. His career development plan, targeted to this career goal, incorporates a multi-disciplinary program carefully designed to provide an intense, closely mentored, implementation research experience in combination with a structured didactic curriculum. The candidate will conduct the proposed research in rural western Kenya in collaboration with the United States Agency for International Development-Academic Model Providing Access to Healthcare (AMPATH) Partnership.
Aim 1 is to evaluate facilitators and barriers to implementation of nurse-based management of hypertensive patients, by conducting a rapid assessment procedure.
Aim 2 is to utilize a participatory, iterative, human-centered design process to develop a smartphone-based decision support and integrated record-keeping (DESIRE) tool to be used by nurses for hypertension management.
Aim 3 is to conduct an impact evaluation of a pilot program for nurse-based management of hypertension to be implemented by AMPATH.
Aim 4 is to estimate the nurse workforce requirements for stable, long-term treatment of hypertension using a needs-based workforce estimation model.
The specific aims will be accomplished under the guidance of a multidisciplinary team of mentors and advisors with complementary expertise. The project is guided by the following career objectives: 1) develop expertise in qualitative methods and community-based participatory research;2) develop competence in management sciences and human performance engineering;3) acquire skills in advanced biostatistical and impact evaluation methods;and 4) acquire knowledge of the methods of operations research and modeling.

Public Health Relevance

Nurse Management of Hypertension in Rural Western Kenya Hypertension is the leading global risk factor for mortality and the global cost of suboptimal blood pressure is estimated to be nearly $1 trillion over the next decade. This project therefore aims to address a singularly critical health and development issue for low- and middle-income countries. The results of this work will add to the emerging body of knowledge on scalable and sustainable strategies for effectively managing hypertension and related chronic diseases in low- and middle-income countries, as well as resource-poor settings in the USA and other high-income countries.

National Institute of Health (NIH)
Fogarty International Center (FIC)
Research Scientist Development Award - Research & Training (K01)
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Special Emphasis Panel (ZRG1-AARR-H (55))
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Jessup, Christine
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Icahn School of Medicine at Mount Sinai
Internal Medicine/Medicine
Schools of Medicine
New York
United States
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Hadley, Michael B; Baumgartner, Jill; Vedanthan, Rajesh (2018) Developing a Clinical Approach to Air Pollution and Cardiovascular Health. Circulation 137:725-742
Manini, Alex F; Nair, Ajith P; Vedanthan, Rajesh et al. (2017) Validation of the Prognostic Utility of the Electrocardiogram for Acute Drug Overdose. J Am Heart Assoc 6:
Pastakia, Sonak D; Manyara, Simon M; Vedanthan, Rajesh et al. (2017) Impact of Bridging Income Generation with Group Integrated Care (BIGPIC) on Hypertension and Diabetes in Rural Western Kenya. J Gen Intern Med 32:540-548
Bansilal, Sameer; Vedanthan, Rajesh; Kovacic, Jason C et al. (2017) Rationale and Design of Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health (FAMILIA). Am Heart J 187:170-181
Vedanthan, Rajesh; Kamano, Jemima H; Lee, Hana et al. (2017) Bridging Income Generation with Group Integrated Care for cardiovascular risk reduction: Rationale and design of the BIGPIC study. Am Heart J 188:175-185
Vedanthan, Rajesh; Bernabe-Ortiz, Antonio; Herasme, Omarys I et al. (2017) Innovative Approaches to Hypertension Control in Low- and Middle-Income Countries. Cardiol Clin 35:99-115
Ragupathi, Loheetha; Stribling, Judy; Yakunina, Yuliya et al. (2017) Availability, Use, and Barriers to Cardiac Rehabilitation in LMIC. Glob Heart 12:323-334.e10
Mitter, Sumeet S; Vedanthan, Rajesh; Islami, Farhad et al. (2016) Household Fuel Use and Cardiovascular Disease Mortality: Golestan Cohort Study. Circulation 133:2360-9
Abdalla, Marwah; Kovach, Neal; Liu, Connie et al. (2016) The Importance of Global Health Experiences in the Development of New Cardiologists. J Am Coll Cardiol 67:2789-2797
Gómez-Pardo, Emilia; Fernández-Alvira, Juan Miguel; Vilanova, Marta et al. (2016) A Comprehensive Lifestyle Peer Group-Based Intervention on Cardiovascular Risk Factors: The Randomized Controlled Fifty-Fifty Program. J Am Coll Cardiol 67:476-85

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