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

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.