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2017 CLUBMEDS

A CLUB-based MEDication delivery Strategy for patients with hypertension in Nigeria (CLUBMEDS): A feasibility study

The CLUBMEDS team

Emily Atkins PhD

Emily is a postdoctoral research fellow with the Cardiovascular Division at The George Institute for Global Health. She completed her undergraduate (BHlthSc, 1st class Hons) and postgraduate studies (Ph.D.) at the University of Western Australia. Emily’s Ph.D. studies used linked administrative hospital morbidity, deaths, and pharmacy data to investigate the cost-effectiveness of cardiovascular medicines for secondary prevention of atherothrombotic disease. Her current work is focused on the use of combination pills, their impact on cardiovascular risk-factor control, and their use in high- and low-resource settings.

Godsent Isiguzo

Lilian Mbau MBChB, MPH, MBA

Dr Lilian Mbau is a medical doctor and a public health practitioner working with Amref Health Africa in Kenya. She currently leads the Non-communicable Disease (NCD) programming within the organization. She received a Global Executive Master of Business Administration in Health from United States International University and is completing her Master of Public Health degree from Moi University. She is currently researching on effective models to sustainably deliver non-communicable disease interventions in low resource settings with a focus on integration. Dr. Mbau has also recently completed a Global Health Leadership Fellowship program with the Afya Bora Consortium and is also an awardee for a Cancer Advocacy grant from the American Cancer Society. She has also received training on Global Issues on NCDs at the London School of Tropical Medicine and Hygiene.

Augustine Odili MBBS, FMCP

Augustine Odili is an associate professor and consultant cardiologist in the Department of Internal Medicine, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja.  He is formerly the Deputy Dean, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja. Dr. Odili graduated from the prestigious University of Nigeria, Enugu Campus with a distinction in Medical Physiology. He had his postgraduate training at the Jos University Teaching Hospital under the National Postgraduate Medical College of Nigeria from where he graduated in 2006 with two awards viz the Best Part II and the Best Overall Candidate in Internal Medicine. He won various other scholarships through which he acquired further training in Internal Medicine, Clinical Cardiology and Cardiovascular Epidemiology. These include the Royal College of Physicians visiting Fellowship to St. Thomas Hospital, London, the Coimbra Group Scholarship for Young African Scholars to the University of Leuven, Belgium; International Fellowship on Cardiovascular Epidemiology and Prevention at Hyderabad, India.

Rajmohan Panda MD, MPH

Dr. Rajmohan Panda (Raj) is a Senior Public Health Specialist and Additional Professor at the Public Health Foundation of India (PHFI). He is a preventive medicine specialist with further training in global health leadership at Emory University in the USA. Dr Panda is adept in leading operational research projects in India and had considerable experience in the application of mixed methodology, epidemiological study designs in various projects in health systems strengthening in India. He has led many projects in tobacco control including a health system intervention project by BMGF on Strengthening Tobacco Control. Dr Panda has a certificate in the Global Tobacco Control Leadership Program from the Institute for Global Tobacco Control, JHSPH, 2013 and a fellowship from the Public Health Leadership and Implementation Academy (PH-LEADER) for NCDs at Emory University, Rollins School of Public Health, Atlanta in 2014.

Shiva Raj Mishra MPH

Shiva Raj Mishra is a cardiovascular epidemiologist, trained in Australia and Nepal. He is a recipient of the prestigious Australia Award Scholarship from 2015-2016. Shiva has interests in global Non-communicable diseases and medicine policy research in low-income settings with an emphasis on cardiovascular diseases and diabetes. He also wrote prolifically on the disaster response and recovery on the aftermath of Nepal earthquakes contributing to several publications. He is the Founding Chief Editor of The Health Prospect and Assoc. Editor of BMC Public Health. Also, he served as a commissioner at The Lancet Youth Commission on Essential Medicine Policies from 2015-2016, and freelance writer for The Lancet, The Lancet Diabetes Endocrinology and WHO Bulletin contributing to several news features from 2015-16. In Nepal, he is affiliated with Nepal Development Society, a community-NGO as a founding member and research advisor since 2014.

Karla Santo MD

Karla is a cardiologist from Rio de Janeiro, Brazil. She graduated in medicine in 2008 at the University of the State of Rio de Janeiro. She completed her medical training in internal medicine in 2011, her cardiology training in 2013, both in Brazil; and she is currently a fellow of the Brazilian Society of Cardiology. After completing her medical training, her strong desire to continuously develop herself and improve her research skills has led her to pursue a Ph.D. degree in the Cardiovascular Division at The George Institute for Global Health and the School of Public Health at the University of Sydney.

Salim Virani MD, Ph.D

Salim S. Virani, MD, Ph.D., is an Associate Professor in the Cardiovascular Research Section at Baylor College of Medicine in Houston, Texas. He is a Cardiologist with specialized training in Lipids. His research portfolio aims to understand several domains in the delivery of high-quality cardiovascular care (especially risk factor control) including effectiveness, equity, safety, and efficiency.  He has been a recipient of the Scott Grundy Award for Excellence in Lipids Metabolism Research from the American Heart Association (AHA) and the Jeremiah Stamler Distinguished Young Investigator Research Award. Dr. Virani serves on the AHA’s Statistics Committee, the AHA’s Prevention Science Committee, and as the Chair for the Research and Publications Committee of the American College of Cardiology’s (ACC) PINNACLE Registry. He also serves as the Associate Editor for Innovations for ACC.org and the Editorial Lead for the prevention-related content for the ACC’s educational website.

Background

Hypertension is the main driver of the rising global burden of disease (GBD), being the largest contributor to the non-communicable diseases (NCDs) burden in the world. Despite concerted efforts to mitigate the impact of hypertension worldwide, it remains a major threat, causing 9.4 million deaths per year. In 2010, high blood pressure ranked as the leading single risk factor for GBD. In a recent meta-analysis, the prevalence of hypertension was estimated to be 28.5% of the population in high-income countries (HIC) and 31.5% in low and middle-income countries (LMIC), accounting for 349 million and 1.04 billion people living with hypertension respectively in 2010. Proportions of awareness, treatment and control of hypertension are smaller in LMICs when compared to HIC and, in 2010, these estimated proportions were 37.9%, 29% and 7.7%, respectively.

Specific Aims

1. To perform a formative feasibility evaluation of a club-based medication delivery strategy using the RE-AIM framework to evaluate the strategy’s potential reach, effectiveness, adoption, implementation, and maintenance. There will be a focus on the reach, adoption and implementation dimensions of the RE-AIM framework with other domains (effectiveness, and maintenance) being secondary outcomes.

2. To perform a pilot study to determine whether a club-based medication delivery strategy using role-model patients as the club facilitators is feasible and acceptable to all the local stakeholders involved in the care of patients with hypertension in Southeast Nigeria.

Methodology

The structure of the CLUBMEDS strategy mimics the structure used in the ART adherence club, however, the role of the club facilitators will be performed by the expert/role model patients instead of paid lay workers, and the role of the club professional nurse will be performed by the community health extension workers (CHEWs).

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