Uptake of Task-Strengthening Strategy for Hypertension (TASSH) control within Community-Based Health Planning Services i

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Uptake of Task-Strengthening Strategy for Hypertension (TASSH) control within Community-Based Health Planning Services in Ghana: study protocol for a cluster randomized controlled trial Kwaku Poku Asante1*†, Juliet Iwelunmor2†, Kingsley Apusiga3, Joyce Gyamfi4, Solomon Nyame1, Kezia Gladys Amaning Adjei3, Angela Aifah4, Kwame Adjei1, Deborah Onakomaiya4, William F. Chaplin5, Gbenga Ogedegbe4† and Jacob Plange-Rhule3†ˆ

Abstract Background: Physician shortage is a major barrier to hypertension (HTN) control in Ghana, with only one physician to 10,000 patients in 2015, thus limiting its capacity for HTN control at the primary care level such as the Community Health Planning and Services (CHPS) compounds, where most Ghanaians receive care. A Task-Shifting Strategy for HTN control (TASSH) based on the WHO Cardiovascular (CV) Risk Package is an evidence-based strategy for mitigating provider- and systems-level barriers to optimal HTN control. Despite its effectiveness, TASSH remains untested in CHPS zones. Additionally, primary care practices in low- and middle-income countries (LMICs) lack resources and expertise needed to coordinate multilevel system changes without assistance. The proposed study will evaluate the effectiveness of practice facilitation (PF) as a quality improvement strategy for implementing TASSH within CHPS zones in Ghana. Methods: Guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we will evaluate, in a hybrid clinical effectivenessimplementation design, the effect of PF on the uptake of an evidence-based TASSH, among 700 adults who present to 70 CHPS zones with uncontrolled HTN. Components of the PF strategy include (a) an advisory board that provides leadership support for implementing the intervention within the CHPS zones and (b) trained task-strengthening facilitators (TSFs) who serve as practice coaches to provide training, and performance feedback to community health officers (CHOs) who will deliver TASSH at the CHPS zones. For this purpose, the TSFs are trained to identify, counsel, and refer adults with uncontrolled HTN to community health centers in Bono East Region of Ghana. (Continued on next page)

* Correspondence: [email protected] ˆJacob Plange-Rhule is deceased. † Kwaku Poku Asante, Juliet Iwelunmor, Gbenga Ogedegbe and Jacob Plange-Rhule contributed equally to this work. 1 Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo, Ghana Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material i