ArticleBMJ open2025
Implementation of a large-scale hypertension program in primary health centres in the Federal Capital Territory, Nigeria: an explanatory, sequential mixed-methods study.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Impact evaluation of the Hypertension Treatment in Nigeria program using the Translational Science Benefits Model.Journal of clinical and translational science · 2026Article
- Design and implementation of a drug revolving fund for hypertension treatment in primary care setting of the Federal Capital Territory, Nigeria.BMJ global health · 2025Article
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Authors and funding
15 authors.
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Abstract
introductionTo 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.
methodsWe 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.
resultsProgram 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.
conclusionOur 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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