Project Abstract: PT4A (Peers and Technology for Adherence, Access, Accountability, and Analytics) Elevated blood pressure (BP) is the leading risk for mortality worldwide. Medication non-adherence is a major cause of uncontrolled hypertension and increases cardiovascular morbidity and mortality. Barriers to medication adherence occur at both the macro- (e.g. health systems and communities) and micro- (e.g., individual patients and providers) levels, influencing both daily implementation of the regimen, and persistence of the regimen over time. Contextual and culturally appropriate interventions are required to improve adherence to hypertension medications. Peer-based support and health information technology (HIT) improve outcomes in chronic disease management; however, the impact of integrated peer-based drug delivery and HIT to improve adherence to hypertension medications is unknown. Therefore, the overall objective of this proposal is to utilize transdisciplinary, translational implementation research, guided by the PRECEDE- PROCEED framework, to address the challenge of hypertension medication non-adherence in low-resource settings. We propose to test the hypothesis that peer delivery of medications combined with HIT (PT4A) will be effective in improving hypertension medication adherence among patients with uncontrolled hypertension in western Kenya by synergistically addressing the barriers to hypertension control at the micro- and macro- levels. Aim 1 will identify contextual barriers and facilitators that might impact hypertension medication adherence, as well as implementation of the PT4A intervention, using a combination of qualitative analysis techniques. We will then use a human-centered design approach to refine the PT4A intervention using the findings from Aim 1. Aim 2 will evaluate the effectiveness of the intervention by conducting a two-arm cluster randomized controlled implementation research hybrid type 2 trial among patients with uncontrolled hypertension, comparing the intervention that integrates peer delivery and HIT (PT4A) to usual care. The primary biological outcome is change in systolic blood pressure at one year. The primary adherence outcome is the pill count adherence ratio. The primary implementation outcome is fidelity to the PT4A intervention. We will also evaluate whether spatial risk factors moderate the relationship between the intervention and the outcomes, and conduct a process evaluation of the implementation of the PT4A intervention according to the Saunders Framework. Aim 3 will evaluate scalability of the PT4A intervention through multiple-criteria decision analysis, qualitative analysis of adaptation factors, and quantitative transportability analysis. The research will be conducted by a transdisciplinary research team with diverse and complementary expertise led by two experienced Principal Investigators. We intend to add to existing knowledge of innovative and scalable strategies to improve adherence ...