# The ADHINCRA Study: Addressing HypertensIoN Care in AfRicA > **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2024 · $648,073 ## Abstract Project Summary/Abstract Innovation in chronic disease management is urgently needed to effectively control hypertension (HTN) in Ghana and Nigeria. Both countries are suffering silent epidemics of chronic diseases with rates closely resembling those of high-income countries. Uncontrolled HTN causes cardiovascular disease, stroke, chronic kidney disease, and premature death. However, HTN is poorly controlled in both countries due to patient-, provider, and system-level barriers. A pressing global health challenge is implementing evidence-based and contextually appropriate strategies to improve chronic disease management in Ghana and Nigeria. Multilevel interventions improve HTN control. For instance, team-based care, a health systems-level and organizational intervention, improves the quality of HTN care. Telehealth can be enhanced with home blood pressure monitoring (HBPM) to address patient-, and provider-level barriers. The COVID-19 pandemic has spurred efforts to increase access to timely and appropriate care through re-engineering primary care to be patient- centered and digitally enabled. Sphygmo Home, a remote telemonitoring app that links with validated blood pressure (BP) and glucose monitoring devices, is a promising solution to improve patients’ self-management of chronic disease. In a previous pilot study, we investigated the impact of a multilevel and digitally-enabled home- based intervention compared to enhanced usual care (UC). After 12 months, 80.5% in the intervention arm, compared to 24.2% in the enhanced UC arm, had controlled BP (p <0.001). Given the promising findings, we designed a larger scale trial, consisting of an innovative multilevel intervention linking HBPM with a telemonitoring platform (Sphygmo Home app), team-based care including physicians and nurses, and the use of simplified hypertension treatment protocol at hospitals, to improve HTN control. Using a hybrid type 2 effectiveness-implementation design among 800 adults with uncontrolled HTN clustered in 16 hospitals across 3 regions (Ashanti, Northern, and Bono) in Ghana and in Ondo state, Nigeria, we seek to 1) Assess the effect of the ADHINCRA Program in improving BP control at 12 months using a stepped wedge cluster randomized trial of adults with uncontrolled HTN (systolic BP ≥140 mm Hg) and 2) Use the Pragmatic Robust Implementation and Sustainability Model (PRISM) to evaluate the reach, adoption, and maintenance of the ADHINCRA Program at 12- and 24-months post-randomization and explore contextual factors that are associated with the adoption and maintenance of the program in each site using the Service Availability and Readiness Assessment (SARA) tool. Through early and continued stakeholder engagement with health system leaders, providers, and patients, we seek to close the wide “know-do-gap” and reduce global chronic disease disparities. We also propose a comprehensive dissemination strategy to reach critical audiences and achieve buy-in, policy, and pr... ## Key facts - **NIH application ID:** 10945648 - **Project number:** 1R01HL175642-01 - **Recipient organization:** JOHNS HOPKINS UNIVERSITY - **Principal Investigator:** Yvonne Commodore-Mensah - **Activity code:** R01 (R01, R21, SBIR, etc.) - **Funding institute:** NIH - **Fiscal year:** 2024 - **Award amount:** $648,073 - **Award type:** 1 - **Project period:** 2024-09-15 → 2029-06-30 ## Primary source NIH RePORTER: https://reporter.nih.gov/project-details/10945648 ## Citation > US National Institutes of Health, RePORTER application 10945648, The ADHINCRA Study: Addressing HypertensIoN Care in AfRicA (1R01HL175642-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10945648. Licensed CC0. --- *[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*