Community Health Worker-led Hypertension Management

NCT ID: NCT06444308

Last Updated: 2025-12-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

460 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-09-09

Study Completion Date

2026-09-30

Brief Summary

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This study is to determine if hypertension management by community health workers (CHW) supported by a mobile health application and remote physician supervision is non-inferior to management by a physician for the primary outcome of improvement in systolic blood pressure. The target population is patients with hypertension in rural Guatemala. Study duration will be 12-24 months.

Detailed Description

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The investigators have developed an innovative system of care utilizing CHWs equipped with a mobile application and supported and supervised remotely by physicians. This model of care is adapted from a CHW-led diabetes program enabled by a similar CDS application which the investigators implemented in the same communities in rural Guatemala where we will carry out this proposed study. This program safely led to significant improvements in glycemic control. The mobile application is built on the widely-used CommCare platform and provides clinical decision support (CDS) to CHWs based on protocols from the WHO and the International Society of Hypertension for antihypertensive medication initiation and titration, lifestyle counseling, and identification of patients requiring a higher level of care.

The Primary Objective is to determine if hypertension management by CHWs is non-inferior to care provided directly by a physician.

The Secondary Objective is to evaluate the safety, acceptability to patients, and cost of CHW-led care compared to care provided directly by a physician.

Conditions

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Hypertension

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

cluster randomized, controlled, non-inferiority trial, each of 15 clusters of geographically grouped communities in the San Lucas Toliman municipality of Guatemala will be randomized to either CHW or physician care
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Community Health Worker Care

Multimodal health systems intervention: hypertension management by trained CHWs equipped with a mobile clinical decision support (CDS) application and remote supervision and support by physicians. CHWs will meet with patients each month and, with the assistance of the CDS application, follow physician-approved and evidence-based protocols to initiate and titrate antihypertensives and medications to reduce cardiovascular risk; identify potential complications of hypertension or problems with medications; and provide lifestyle counseling. For patients with comorbid hypertension and diabetes, CHWs will also manage glycemic therapy and assess for diabetes complications with the assistance of the application.

Group Type EXPERIMENTAL

CommCare with Mobile Clinical Decision Support (CDS) Application

Intervention Type OTHER

For those assigned to the CHW arm, management will be assisted by CDS from the CommCare application.

Remote Supervision by Physicians

Intervention Type OTHER

teleconsultation with a supervising physician

Physician Care

Group Type ACTIVE_COMPARATOR

CommCare Application without CDS

Intervention Type OTHER

The physician will have received training and orientation on the same clinical protocols followed by the CHWs, as well as access to reference materials for these protocols, but the version of the CommCare application used will not provide CDS, but will serve to record and review patient data only.

Interventions

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CommCare with Mobile Clinical Decision Support (CDS) Application

For those assigned to the CHW arm, management will be assisted by CDS from the CommCare application.

Intervention Type OTHER

Remote Supervision by Physicians

teleconsultation with a supervising physician

Intervention Type OTHER

CommCare Application without CDS

The physician will have received training and orientation on the same clinical protocols followed by the CHWs, as well as access to reference materials for these protocols, but the version of the CommCare application used will not provide CDS, but will serve to record and review patient data only.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adults age 18 or greater with diagnosis of hypertension AND blood pressure (BP) greater than or equal to 140/90 OR currently taking antihypertensive medication.
* Ability to provide informed consent

Exclusion Criteria

* Pregnancy
* Severe comorbid condition(s) with life expectancy less than 1 year
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fogarty International Center of the National Institute of Health

NIH

Sponsor Role collaborator

University of Wisconsin, Madison

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Sean Duffy, MD

Role: PRINCIPAL_INVESTIGATOR

University of Wisconsin, Madison

Locations

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Community

San Lucas Tolimán, , Guatemala

Site Status RECRUITING

Countries

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Guatemala

Central Contacts

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Sean Duffy, MD

Role: CONTACT

608-354-7930

Other Identifiers

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A532050

Identifier Type: OTHER

Identifier Source: secondary_id

Protocol Version 8/27/25

Identifier Type: OTHER

Identifier Source: secondary_id

4R33TW011891-03

Identifier Type: NIH

Identifier Source: secondary_id

View Link

2024-0566

Identifier Type: -

Identifier Source: org_study_id

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