Implementation outcomes from the Hypertension Treatment in Nigeria program: results from a type 2 hybrid interrupted time series trial

Abstract

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.