Peer Counselor Intervention for Reducing Mortality and/or Hospitalization in Adults With Hypertensive Urgency in Tanzania: A Pilot Study

Peer Counselor Intervention for Reducing Mortality and/or Hospitalization in Adults With Hypertensive Urgency in Tanzania: A Pilot Study

Abstract BACKGROUND Worldwide, people with hypertensive urgency experience high rates of hospitalization and death due to medication non-adherence. Interventions to improve medication adherence and health outcomes after hypertensive urgency are urgently needed. METHODS This prospective cohort assess...

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Bibliographic Details
Published in:American journal of hypertension Vol. 36; no. 8; pp. 446 - 454
Main Authors: Kisigo, Godfrey A, Mgeta, Frank, Mcharo, Onike, Okello, Elialilia, Wajanga, Bahati, Kalokola, Fredrick, Mtui, Graham, Sundararajan, Radhika, Peck, Robert N
Format: Journal Article
Language:English
Published: US Oxford University Press 14-07-2023
Subjects:
Adult
Counselors
Female
Hospitalization
Humans
Male
Medication Adherence
Middle Aged
Original Contributions
Pilot Projects
Prospective Studies
Tanzania - epidemiology
Tanzania
blood pressure
hospitalization
peer counselor intervention
adherence
Tanzania
mortality
hypertensive urgency
hypertension
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Summary:Abstract BACKGROUND Worldwide, people with hypertensive urgency experience high rates of hospitalization and death due to medication non-adherence. Interventions to improve medication adherence and health outcomes after hypertensive urgency are urgently needed. METHODS This prospective cohort assessed the effect of a peer counselor intervention—named Rafiki mwenye msaada—on the 1-year incidence of hospitalization and/or death among adults with hypertensive urgency in Mwanza, Tanzania. We enrolled 50 patients who presented with hypertensive urgency to 2 hospitals in Mwanza, Tanzania. All 50 patients received a Rafiki mwenye msaada an individual-level, time-limited case management intervention. Rafiki mwenye msaada aims to empower adult patients with hypertensive urgency to manage their high blood pressure. It consists of 5 sessions delivered over 3 months by a peer counselor. Outcomes were compared to historical controls. RESULTS Of the 50 patients (median age, 61 years), 34 (68%) were female, and 19 (38%) were overweight. In comparison to the historical controls, the intervention cohort had a significantly lower proportion of patients with a secondary level of education (22% vs. 35%) and health insurance (40% vs. 87%). Nonetheless, the 1-year cumulative incidence of hospitalization and/or death was 18% in the intervention cohort vs. 35% in the control cohort (adjusted Hazard Ratio, 0.48, 95% CI 0.24–0.97; P = 0.041). Compared to historical controls, intervention participants maintained higher rates of medication use and clinic attendance at both 3- and 6-months but not at 12 months. Of intervention participants who survived and remained in follow-up, >90% reported good medication adherence at all follow-up time points. CONCLUSION Our findings support the hypothesis that a peer counselor intervention may improve health outcomes among adults living with hypertensive urgency. A randomized clinical trial is needed to evaluate the intervention’s effectiveness. Graphical Abstract Graphical Abstract
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ISSN:0895-7061
1941-7225
DOI:10.1093/ajh/hpad037