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Original Research

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

Authors:

Ana A. Baumann,

Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, US
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Vincent Mutabazi,

Regional Alliance for Sustainable Development, Kigali, RW
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Angela L. Brown,

Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, US
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Cole Hooley,

Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, US
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Dominic Reeds,

Division of Geriatrics and Nutritional Science, Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, US
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Cecile Ingabire,

School of Nursing and Midwifery, University of Rwanda, Kigali, RW
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Vedaste Ndahindwa,

School of Nursing and Midwifery, University of Rwanda, Kigali, RW
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Aurore Nishimwe,

School of Health Sciences, University of Rwanda, Kigali, RW
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W. Todd Cade,

Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, US
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Lisa de las Fuentes,

Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO; Divisions of Biostatistics, Washington University School of Medicine, St. Louis, MO, US
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Enola K. Proctor,

Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, US
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Stephen Karengera,

Regional Alliance for Sustainable Development, Kigali; EAC RCE-VIHSCM, College of Medicine and Heath Sciences, University of Rwanda, Kigali, RW
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Kenneth B. Schecthman,

Divisions of Biostatistics, Washington University School of Medicine, St. Louis, MO, US
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Charles W. Goss,

Divisions of Biostatistics, Washington University School of Medicine, St. Louis, MO, US
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Kevin Yarasheski,

C2N Diagnostics, LLC, St. Louis, MO, US
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Brad Newsome,

National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, US
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Eugene Mutimura,

Regional Alliance for Sustainable Development, Kigali, RW
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Victor G. Davila-Roman

Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, US
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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 latephase 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 HTNCVD 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.

Highlights

  • Implementation research in LMIC has been challenging due to limited capacity.
  • A training program was developed to support implementation research strategies in Rwanda.
  • Implementation research training resulted in significant increases in knowledge and skills.
How to Cite: Baumann AA, Mutabazi V, Brown AL, Hooley C, Reeds D, Ingabire C, et al.. Dissemination and Implementation Program in Hypertension in Rwanda: Report on Initial Training and Evaluation. Global Heart. 2019;14(2):135–41. DOI: http://doi.org/10.1016/j.gheart.2019.06.001
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Published on 01 Jun 2019.
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