Testing community-based strategies to increase hypertension screening in Nigeria: a protocol for an effectiveness-implementation hybrid type III cluster-randomized trial

BACKGROUND: Hypertension is a major risk factor for cardiovascular disease and stroke, with a growing burden in Nigeria. Limited access to blood pressure (BP) screenings, low awareness, and barriers to healthcare drive low diagnosis rates. Community-based screenings for other conditions have been successful and could improve diagnosis and care linkage. This study evaluates the effectiveness of a community-based screening and referral intervention to increase hypertension detection and facilitate connections to healthcare. METHODS: This cluster-randomized effectiveness-implementation hybrid type III trial in Nigeria tests the implementation and effectiveness of a community-based BP screening intervention. There are two arms: 1). Core: community screenings supported by mobile health technology with referral to a healthcare facility for participants with at least one elevated BP reading, and 2.) Core+ (enhanced): additional support from community health advisors to help participants link to healthcare facilities. Participants with elevated BP will be informed about medication vouchers if diagnosed with hypertension and prescribed medication. Community gathering sites hosting screenings leverage local engagement structures. The study will assess the proportion of individuals identified to have elevated BP, rates of linkage to healthcare facilities, and factors influencing intervention uptake and sustainability. DISCUSSION: To address gaps in hypertension detection and management utilizing community-based strategies, findings will provide insights into the feasibility and effectiveness of implementing a scalable, community-driven approach to hypertension screening and linkages to healthcare in Nigeria. If successful, this model could be adapted to other resource-limited settings in the United States and globally to improve detection and reduce hypertension-related complications. NAME OF REGISTRY: CLINICALTRIALS.GOV: Trial Registration NCT06659900. Registered 26 October 2024, prospectively registered. https://clinicaltrials.gov/study/NCT06659900?id=NCT06659900&rank=1.