January 1, 2025HeliyonOpen Access

Community-based model for management and follow-up by non-physician healthcare workers to improve awareness, treatment, and control of hypertension: The COTRACO study protocol

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Why the study?

Hypertension remains under-diagnosed and poorly controlled in low- and middle-income countries, prompting evaluation of a standardized community-based treatment approach delivered by non-physician healthcare workers.

Does a community-based model involving non-physician health workers improve hypertension control compared to standard care in patients with hypertension?

Structured PICO

Does a community-based model involving non-physician health workers improve hypertension control compared to standard care in patients with hypertension?

Population

2,100 patients with hypertension (600 in Colombia and the Dominican Republic, 300 in Chile, and 1,200 in Spain)

Intervention

Community-based model involving non-physician health workers (NPHWs) to apply standardized treatment algorithms, promote adherence to healthy lifestyles, and provide standardized pharmacological treatment

Comparator

Standard care (propensity score matched patients in Chile and Spain)

Outcome

Percentage of patients achieving controlled hypertension (systolic BP < 140 mmHg and diastolic BP < 90 mmHg, or < 130 mmHg and diastolic BP < 80 mmHg for diabetic patients) at 12 months of follow-upsurrogate

This study protocol outlines a quasi-experimental trial to evaluate whether a community-based model using non-physician health workers can improve hypertension control in low- and middle-income countries.

Implication

Protocol tests NPHW-led hypertension care in Colombia; leaves open whether HOPE-4 benefits translate to Latin America.

Abstract

Introduction: Cardiovascular diseases are the leading cause of death and morbidity worldwide, with a significantly higher burden in low- and middle-income countries. Hypertension, a major risk factor for cardiovascular morbidity and mortality, remains under-diagnosed and poorly controlled, especially in regions such as Latin America. The HOPE-4 study demonstrated that the involvement of non-physician health workers (NPHWs), the use of standardized treatment algorithms, the provision of free antihypertensive drugs and home follow-up can significantly improve hypertension control and reduce cardiovascular risk, as demonstrated in Colombia and Malaysia. On this basis, the COTRACO study aims to address the barriers to hypertension treatment in low- and middle-income countries by implementing a similar standardized treatment approach delivered by non-specialist health workers. Methodology: The COTRACO study is a quasi-experimental, parallel-group, non-randomized, before-and-after study. A community-based model will be implemented in 600 patients in Colombia and the Dominican Republic, involving NPHWs to: 1) apply standardized treatment algorithms, 2) promote adherence to healthy lifestyles, and 3) provide standardized pharmacological treatment. Propensity Score Matching will be used to select 300 patients in Chile and 1200 in Spain for comparison with standard care in these populations. Expected outcomes: The primary outcome at 12 months of follow-up is the percentage of patients achieving controlled hypertension (defined as systolic BP < 140 mmHg and diastolic BP < 90 mmHg, or < 130 mmHg, and diastolic BP < 80 mmHg for diabetic patients), ensuring it is not inferior to that achieved in the control countries. Secondary outcomes include changes in BP levels, cholesterol levels, BMI, handgrip strength, waist-to-hip ratio, smoking status, Interheart risk score, diet, and physical activity at 6 and 12 months. Recommendations: If this model demonstrates superior outcomes compared to usual care, it is recommended that health authorities in low- and middle-income regions adopt and implement this approach. Using non-medical health professionals, standardized treatment algorithms and free access to antihypertensive medications, these regions can significantly improve awareness, diagnosis and management of hypertension. This strategy has the potential to reduce cardiovascular morbidity and mortality, thereby improving overall public health outcomes.