Addressing Hypertension and Diabetes through Community-Engaged Systems (ANDES) in Puno, Peru: rationale and study...

Area of Science:

• Public Health
• Cardiovascular Disease Research
• Health Systems Implementation Science

Background:

• Hypertension is a prevalent cardiovascular disease in Peru, with suboptimal control despite available treatments.
• A hybrid type 2 randomized controlled trial is designed to address this gap within the national primary care system.
• The ANDES study (NCT05524987) focuses on Puno, Peru, integrating community health workers (CHWs) into hypertension management.

Purpose of the Study:

• To test the implementation and effectiveness of a CHW-led hypertension control program.
• To evaluate the impact of the program on blood pressure, medication adherence, and lifestyle factors.
• To provide insights into factors influencing successful implementation and scaling of hypertension management strategies in LMICs.

Main Methods:

• Recruitment of 1068 adult participants with hypertension in Puno, Peru.
• Individual randomization (1:1) to either usual care or a 12-month CHW-led home-based intervention.
• Intervention includes blood pressure monitoring, medication support, and lifestyle counseling, guided by CFIR and RE-AIM frameworks.

Main Results:

• Primary outcome: Mean change in systolic blood pressure.
• Secondary clinical outcomes: Diastolic blood pressure and HbA1C.
• Implementation outcomes: Fidelity, reach, adoption, sustainability, acceptability, and cost-effectiveness will be assessed.

Conclusions:

• The ANDES trial is the first CHW-led strategy in Peru for hypertension and type 2 diabetes management.
• Findings will inform adaptation and scaling of the ANDES strategy in Peru and other LMICs.
• The study supports integrated care approaches, potentially reducing morbidity and mortality.