In response to RFA-HL-17-003, we propose to create a collaborative team of academics, clinicians, community healthcare providers and public health experts to build in-country capacity to conduct late-stage (T4) translation research (TR) for hypertension (HTN) control in Rwanda. HTN is a major risk factor for cardiovascular disease (CVD), and is the leading cause of death in low-income and middle countries (LMICs), killing more people than HIV, malaria, and tuberculosis combined. HTN accounts for ~10.5 million deaths and 12.8% of total global disability adjusted life years. Pilot data suggest that 36% of Rwandan adults have HTN, and 33% are unaware of their HTN. Rwanda has initiated an HIV model of treatment and care for the management of certain non-communicable diseases (NCDs) at tertiary, provincial and district levels of the healthcare pyramid, and data on HTN/CVD care will be exploited to guide U24 planning, practice and dissemination. Despite emerging evidence for effective behavioral change interventions (from high income countries) on HTN control, there is inadequate information on infrastructure and capacity to engage in T4TR for HTN control in Rwanda. The proposed plan will address these gaps: underutilization and limited interventions to disseminate information and implement HTN awareness campaigns and develop sustainable dissemination and implementation (D&I) research. As proposed, the Regional Alliance for Sustainable Development and the University of Rwanda College of Medicine and Health Sciences (UR- CMHS) have partnered with Washington University in St Louis, MO, USA, amalgamated resources and expertise in T4TR, formed training teams, and will implement skills training through in-country workshops, distance learning/training, and mentorships to develop competencies for D&IR. We will implement T4TR curriculum on competencies retention and post-mentorship for junior Scholars and train UR-CMHS faculty through the Continuous Medical Education (CME) Accreditation program. We will develop and validate qualitative and quantitative tools, conduct desk reviews and carry out needs assessments for HTN chronic care, capacity, facilities, resources and capabilities for T4TR to support implementation of evidence-based interventions to reduce HTN/CVD morbidities. We will foster local and US partnerships, including Faith- based and non-governmental organizations and grassroots community-level partners, and leverage resources with existing training programs for sustainable and independent T4TR capacity. We will prioritize intervention areas, develop a research plan, and disseminate findings through community networks, websites, healthcare forums and resource-sharing databases to guide policy and practice. We will collaborate with Steering Committee members to evaluate program progress based on concrete specific aims, milestones and outcome measures. This plan will establish the required network and capacity to propose and conduct high impact T4TR on HTN control and substantially impact public health in Rwanda.
Hypertension (HTN) is a major risk factor for cardiovascular disease (CVD) and a leading cause of death in low-income countries (LICs). HTN is associated with a high death rate due to adverse changes in the heart structure and function including left ventricular hypertrophy, myocardial infarction, atrial fibrillation and congestive heart failure. Although various evidence-based effective interventions for control of HTN in high income countries exist, implementation is challenging in Rwanda like other LICs due to lack of capacity and infrastructure for late-phase (T4) translational research (TR). Thus, developing competencies for a generation of highly skilled Rwandans in T4TR to identify facilities, resources and capabilities to nurture dissemination and implementation research (D&IR) are critical to create context-specific research plan for HTN control in Rwanda.
