# PT4A (Peers and Technology for Adherence, Access, Accountability, and Analytics)

> **NIH NIH R01** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2024 · $660,554

## Abstract

Project Abstract: PT4A (Peers and Technology for Adherence, Access, Accountability, and Analytics)
Medication adherence is critical for hypertension control and improved cardiovascular disease (CVD)
outcomes. However, medication non-adherence is a global problem. While numerous evidence-based
practices to improve medication adherence are available, there are substantial implementation gaps
leading to suboptimal adherence and adverse CVD outcomes. Macro-level barriers include medication
cost, lack of insurance, medication non-availability, and transportation costs. Poor patient-clinician
relationships and mistrust of the health system are micro-level barriers. We hypothesize that an
implementation strategy that synergistically combines peer coaching, peer-based door-to-door medication
delivery, and health information technology (HIT) can address implementation gaps and improve
adherence to hypertension medications. Peer-based medication delivery decreases the cost of
transportation and the opportunity cost of travel and procurement time and can be leveraged to provide
psychosocial support and enhance patient activation. HIT can support peer activities by facilitating
targeted adherence counseling, teleconsultation, synchronization of clinical care and pharmacy activities,
and analytics to improve medication supply. We have implemented a pilot program of door-to-door
peer-based medication delivery and HIT in western Kenya, and preliminary data indicate improved
adherence and blood pressure. However, the effectiveness of this implementation strategy is not fully
established. Therefore, our objective is to use the PRECEDE-PROCEED framework to conduct
transdisciplinary implementation research to test the hypothesis that integrating peer delivery of
medications with HIT (PT4A) improves medication adherence and reduces blood pressure among
patients with uncontrolled hypertension in western Kenya. Aim 1 will evaluate the effectiveness of PT4A
by conducting a two-arm cluster randomized controlled implementation research hybrid type 2 trial,
comparing PT4A to control. The primary biological outcome is one-year change in systolic blood pressure.
The primary adherence outcome is the pill count adherence ratio. The primary implementation outcome is
fidelity. Secondary outcomes are blood pressure control, self-reported adherence, and RE-AIM metrics.
Aim 2 will evaluate potential mechanistic relationships between implementation measures and outcomes.
Sub Aim 2.1 will evaluate if trust in the health system and patient activation mediate the relationship
between PT4A and the outcomes. Aim 3 will consist of cost-effectiveness, budget impact, and qualitative
analyses to help inform adaptation of PT4A to other settings. The research will be conducted by a
transdisciplinary team with diverse and complementary expertise. We intend to add to existing knowledge
of innovative and scalable strategies to improve medication adherence for global hypertension control.

## Key facts

- **NIH application ID:** 10878462
- **Project number:** 1R01HL162119-01A1
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** BENSON NG'ANG'A NJUGUNA
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $660,554
- **Award type:** 1
- **Project period:** 2024-05-23 → 2028-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10878462

## Citation

> US National Institutes of Health, RePORTER application 10878462, PT4A (Peers and Technology for Adherence, Access, Accountability, and Analytics) (1R01HL162119-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10878462. Licensed CC0.

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