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    Enhancing intergenerational HeAlth in Nigeria: peripartum as Critical life stagE for CardioVascular Health (ENHANCE-CVH) study: findings from pre-implementation using the updated consolidated framework for implementation research (CFIR 2.0)
    (Implementation Science Communications, 2026) Ojji, D.B
    Background Pregnancy is a crucial period to improve cardiovascular health (CVH) for mothers and their families. The current study emphasizes framework-guided factors that influence the adaptation of an evidence-based intervention (Parents as Teachers and Healthy Eating Active Living Taught at Home [PAT+HEALTH]) to support healthy gestational weight gain and postpartum weight management among pregnant women with obesity and their infants in Nigeria. Methods From May to June 2023, 43 in-depth interviews were conducted with 11 parents, 15 community health extension workers (CHEWs)/health educators, and 17 policymakers/ healthcare supervisors in the Federal Capital Territory, Nigeria. Additionally, nine focus groups were conducted with 75 participants. Interviews were recorded, de identified, and transcribed. The updated Consolidated Framework for Implementation Research (CFIR 2.0) informed the development of the interview guides and the thematic analysis. Transcripts were double-coded using Dedoose. Results We identified assessing context, tailoring strategies, local attitudes, and sustainability as constructs to consider when adapting and implementing the PAT+HEALTH intervention successfully within the Nigerian primary care context. For example, policymakers and healthcare supervisors emphasized the feasibility of the intervention, includ ing raising community awareness, planning for hard-to-reach areas, and ensuring supportive supervision of CHEWs delivering the intervention. Additional factors included customizing educational content and delivery methods to fit the cultural, socioeconomic, and environmental contexts of Nigerian families. CHEWs highlighted the importance of public education on locally available including limited financial support for the long-term sustainability of some components of the home visiting program. Conclusions Building on these formative activities, the ENHANCE CVH trial will advance dissemination and imple mentation science by adapting, testing, and evaluating the effectiveness and implementation of the PAT+HEALTH intervention among pregnant women with obesity and their infants in Nigeria in a cluster randomized trial.
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    Implementation of a large-scale hypertension program in primary health centres in the Federal Capital Territory, Nigeria: an explanatory, sequential mixed-methods study
    (BMJ Open, 2025-07-01) Ojji, D.B
    Introduction To optimise hypertension care cascade, the multilevel Hypertension Treatment in Nigeria (HTN) Program, adapted from the WHO HEARTS package, was implemented within 60 primary healthcare centres (PHCs) in the Federal Capital Territory, Nigeria, from January 2020 to December 2023. Methods We conducted an explanatory sequential mixed methods study, guided by the RE-AIM QuEST (Reach, Effectiveness, Adoption, Implementation, and Maintenance - Qualitative Evaluation for Systematic Translation) framework, to examine the factors influencing reach, effectiveness, adoption, implementation, acceptability and maintenance of the program. We conducted 13 focus group discussions in a subset of PHCs with patients (n=17), community health workers (n=35), pharmacy technicians (n=18) and PHC directors (n=5). Eighteen sites were purposively selected based on facility performance, targeting sites in the top and bottom 12% of blood pressure (BP) control at the end of the HTN Program. Qualitative data were coded, and subthemes were generated using directed content analysis. Results Program reach was facilitated by community education, peer influence and decentralisation of hypertension services. Patients perceived the program to be effective, citing successful BP control, fewer medication side effects and support for improving health behaviours. Adoption and fidelity were supported through training and supportive supervision strategies. Multiple outcomes, including reach, acceptability and maintenance, were facilitated by improved affordability of BP-lowering medication through a drug revolving fund scheme which led to minimal stockouts, although medication affordability remained a challenge for some patients. Health workers and directors identified needs for program sustainment, including maintaining their motivation and commitment, strengthening the medication supply chain and advocating for the inclusion of BP-lowering medications in the national health insurance scheme. led to effective implementation of a primary care-based hypertension control program in Nigeria. These insights can support sustainment and nationwide scaling up of the program and inform similar programs in other low-income and middle-income countries. Conclusion Our findings provide an understanding of the implementation strategies and program components that led to effective implementation of a primary care-based hypertension control program in Nigeria. These insights can support sustainment and nationwide scaling up of the program and inform similar programs in other low-income and middle-income countries.
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    Implementation outcomes from the Hypertension Treatment in Nigeria program: results from a type 2 hybrid interrupted time series trial
    (Implementation Science, 2026) Ojji, D.B
    Background The Hypertension Treatment in Nigeria Program was implemented across 60 primary healthcare cent ers (PHCs) in Nigeria to improve hypertension treatment and control using the World Health Organization’s HEARTS package. This study reports the program’s implementation outcomes. Methods The Hypertension Treatment in Nigeria Program used a type 2 hybrid interrupted time series design, and data were collected from January 2020 to December 2023. The RE-AIM (Reach, Effectiveness, Adoption, Imple mentation, and Maintenance) framework guided the evaluation, focusing on key metrics such as patients’ and clinics’ characteristics, prescription rate of fixed dose combination (FDC) drugs, medication availability, and retention. Results Among 21,922 patients recruited (mean [SD] age=49 [12], 68.1% female) from 60 primary healthcare centers (78.3% rural). Prescription of FDC increased from 16.3 (95% CI: 4.8%—27.8%) to 65.2% (95% CI: 64.0%—66.3%). The program distributed 336,116 30-day medication supplies, and nearly all (95%) PHCs had at least one 30-day sup ply of any BP-lowering medication in stock after the drug revolving fund implemented. The patient retention rate at 6 months increased between the pre-implementation to implementation periods from 59.9% to 63.1%. Conclusions The Hypertension Treatment in Nigeria Program successfully integrated hypertension services into Nigerian primary healthcare centers. Future efforts should focus on sustaining and scaling up the program’s success.
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    Hypertension in Sub-Saharan Africa: Burden, Barriers and Priorities for Improving Treatment Outcomes
    (Circulation Research, 2025-07-20) Ojji, D.B
    The burden of hypertension is rising rapidly in sub-Saharan Africa (SSA), posing significant health challenges and economic costs that hinder national development. Despite being well-studied in clinical medicine, the detection, treatment, and control of hypertension in SSA remain inadequate. This is due to barriers across the care continuum, including individual-, provider-, and system-level obstacles within the health system. A critical issue is the lack of contextualized mechanistic research to understand the mechanisms, phenotypes, and treatment responses in native SSA populations. Current treatment approaches are often based on data from diaspora Africans, particularly African Americans. Consequently, most guidelines do not recommend angiotensin system drugs as first-line agents for Black patients, a stance that should be reconsidered given some evidence of their effectiveness in native SSA populations. Addressing these barriers requires a comprehensive, multisectoral strategy that includes both preventative and clinical measures at the population and individual levels. Preventative approaches should encompass health and nutrition education, improving food supply quality, and implementing comprehensive transportation and environmental policies. In addition, strategies should be developed to increase the detection of undiagnosed cases through enhanced screening and treatment access to those not receiving care, and revisit current treatment approaches to ensure that they are more tailored to the specific populations and settings. In conclusion, innovative strategies are needed to identify and overcome barriers to hypertension diagnosis and management. A coordinated, multisectoral approach that includes a contextualized mechanistic research agenda, as well as task shifting and task sharing, will help prevent and reduce hypertension in SSA.
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    Lessons Learnt from HIV and Noncommunicable Disease Healthcare Integration in Sub-Saharan Africa
    (Global Heart, 2024-11-12) Ojji, D.B
    In sub-Saharan Africa (SSA), a rising burden of noncommunicable diseases (NCDs) coexists with a persistent high burden of human immunodeficiency virus (HIV). Integrating care for chronic conditions is potentially beneficial, but the optimal approach remains unclear. By use of a narrative review of 14 recent case studies from different SSA countries, examples of NCD and HIV healthcare integration were described. Case studies were categorized into three models: integrating NCD care into existing HIV care (n = 8), integrating HIV care into existing NCD care (n = 2), and simultaneous implementation of HIV and NCD services (n = 4). Facilitators include staff and patient education, while barriers encompass the lack of guidelines and inadequate infrastructure. Providers, patients, and policymakers support integrated care but note several challenges. Available health economics data suggest cost-effectiveness in the long run. Concluding, NCD and HIV healthcare integration in SSA was deemed feasible with models of service integration related to the implementation context.