Dissemination and Implementation Program in Hypertension in Rwanda: Report on Initial Training and Evaluation

Ana A. Baumann, Vincent Mutabazi, Angela L. Brown, Cole Hooley, Dominic Reeds, Cecile Ingabire, Vedaste Ndahindwa, Aurore Nishimwe, W. Todd Cade, Lisa de las Fuentes, Enola K. Proctor, Stephen Karengera, Kenneth B. Schecthman, Charles W. Goss, Kevin Yarasheski, Brad Newsome, Eugene Mutimura, Victor G. Davila-Roman

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Abstract

Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide and in low- and middle-income countries, and hypertension (HTN) is a major risk factor for CVD. Although effective evidence-based interventions for control of HTN in high-income countries exist, implementation of these in low- and middle-income countries has been challenging due to limited capacity and infrastructure for late-phase translational research. In Rwanda, the 2015 STEPS NCD (STEPwise Approach to Surveillance of Noncommunicable Diseases) risk survey reported an overall prevalence of HTN of 15% (95% confidence interval [CI]: 13.8 to 16.3) for those ages 15 to 64 years; prevalence increased with increasing age to 39% (95% CI: 35.7 to 43.1) for those ages 55 to 64 years; CVD was the third most common cause of mortality (7%). Suboptimal infrastructure and capacity in Rwanda hinders research and community knowledge for HTN control. Objectives: To address the issue of suboptimal capacity to implement evidence-based interventions in HTN, this project was designed with the following objectives: 1) to develop a regional needs assessment of infrastructure for dissemination and implementation (D & I) strategies for HTN-CVD control; 2) to develop HTN-CVD research capacity through creation of countrywide resources such as core research facilities and training in the fields of HTN-CVD, D & I, and biostatistics; and 3) to engage and train multiple stakeholders in D & I and HTN-CVD evidence-based interventions. Methods: A weeklong training program in HTN-CVD, biostatistics, and D & I was conducted in Rwanda in August 2018, and pre- and post-D & I training competency questionnaires were administered. Results: Questionnaire results show a statistically significant increase in D & I knowledge and skills as a result of training (full scale pre- to post-test scores: 2.12 ± 0.78 vs. 3.94 ± 0.42; p < 0.0001). Conclusions: Using principles of community engagement and train-the-trainer methods, we will continue to adapt guidelines and treatments for HTN-CVD developed in high-income countries to the context of Rwanda with the goal of establishing a sustainable platform to address the burden of disease from HTN-CVD.

Original languageEnglish
Pages (from-to)135-141
Number of pages7
JournalGlobal Heart
Volume14
Issue number2
DOIs
StatePublished - Jun 2019

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    Baumann, A. A., Mutabazi, V., Brown, A. L., Hooley, C., Reeds, D., Ingabire, C., Ndahindwa, V., Nishimwe, A., Cade, W. T., de las Fuentes, L., Proctor, E. K., Karengera, S., Schecthman, K. B., Goss, C. W., Yarasheski, K., Newsome, B., Mutimura, E., & Davila-Roman, V. G. (2019). Dissemination and Implementation Program in Hypertension in Rwanda: Report on Initial Training and Evaluation. Global Heart, 14(2), 135-141. https://doi.org/10.1016/j.gheart.2019.06.001