Abstract
Background and Objective: In rural Bangladesh, there are multiple barriers to receiving treatment for hypertension, including distant healthcare facilities [Upazila Health Complex (UHC)] and inadequate numbers of physicians. This pilot aimed to design and assess the feasibility of implementing a community-based (CB) WHO HEARTS package involving non-physician health workers (Community Healthcare Providers [CHCP]) for diagnosing and treating hypertension who are remotely supervised, using telemedicine, by a UHC physician. Methods We are conducting this single-arm pilot study in four Community Clinics (CC) in rural Bangladesh. We included patients with untreated hypertension (blood pressure [BP] 140-180/90-110 mmHg). We excluded patients with diabetes, pregnancy, and cardiovascular and kidney diseases. The CB-HEARTS package intervention components were 1) simplified treatment protocol, 2) reliable medication supply, 3) team-based care, 4) standardized follow-up, and 5) a mobile app to track patients’ BP control. After assessing eligibility, CHCPs from the CC communicated with designated physicians at UHC to confirm hypertension diagnosis and to start anti-hypertensive medications in the CC. Patients with BP controlled (<140/90 mmHg) during follow-up were provided a refill for 3 months. Patients with complications or uncontrolled BP, even after the maximum allowable dose, were referred to the UHC. Outcomes were enrollment and follow-up rates (primary), BP change from baseline and hypertension control (secondary). Results: We screened 4,220 adults, of whom 531 were eligible for the study and 220 were enrolled (Table; mean age 55.9 years, 75.9% female). Enrollment (41.4%) and follow-up within 3 months of enrollment (93.6%) rates were high. Mean systolic and diastolic BP were 153 and 92 mmHg at enrollment, respectively. BP was lowered by 31 mmHg systolic and 15 mmHg diastolic after a mean of 84 days follow-up. After this follow-up duration, 90% of participants had their BP controlled. Conclusions: This pilot study provides evidence that hypertension care provided by non-physician health workers under remote supervision of physicians in rural Bangladesh is feasible and may effectively lower BP and improve hypertension control. Table: Participant screening, enrollment, and follow-up