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Clinical Trial
. 2025 Mar 24;14(1):e003163.
doi: 10.1136/bmjoq-2024-003163.

Supportive supervision visits in a large community hypertension programme in Nigeria: implementation methods and outcomes

Gabriel Lamkur Shedul  1   2 , Nanna Ripiye  3 , Erica L Jamro  4 , Ikechukwu A Orji  3 , Grace Julcit Shedul  3 , Eugenia N Ugwuneji  3 , Emmanuel Okpetu  2   5 , Boni M Ale  6 , Samuel Osagie  3 , Abigail S Baldridge  7   8 , Namratha R Kandula  9 , Mark D Huffman  10   11 , Dike Ojji  3 , Lisa Hirschhorn  2
Affiliations
Clinical Trial

Supportive supervision visits in a large community hypertension programme in Nigeria: implementation methods and outcomes

Gabriel Lamkur Shedul et al. BMJ Open Qual. .

Abstract

Background: The Hypertension Treatment in Nigeria (HTN) Programme established a system for hypertension diagnosis and management in 60 public primary healthcare facilities in the Federal Capital Territory of Nigeria through the implementation of HEARTS, a multi-level strategy bundle including team-based care led by community health extension workers (CHEWs). To improve HEARTS implementation, supportive supervision was added as an implementation strategy in April 2020.

Methods: A multidisciplinary supportive supervision team and data collection forms were developed and implemented at HTN-supported sites. Data from April 2020 to December 2023 from supportive supervision visits were used to measure supportive supervision implementation outcomes, including reach, fidelity, adoption and feasibility and effectiveness of quality of care, data reporting and facility readiness. Descriptive analyses were performed to summarise outcomes. Jonckheere-Terpstra or Cochran-Armitage trend test was used to measure change over time for medians or proportions, respectively.

Results: The programme successfully designed and performed quarterly supportive supervision visits. There was high reach (100% sites with visits each year), fidelity (median 100% (IQR 89%-100%) of core components completed), adoption (100% teams provided quarterly visits) and increase in feasibility (planned visits completed) (90.8% to 97.8%, p=0.002). Effectiveness outcomes included an increase in patients with blood pressure (BP) checked in the last 3 days (78.4% to 84.4%, p=0.009), treatment cards without errors (71.5% to 85%. p<0.001), but a slight drop in CHEW fidelity to BP measurement technique (91.5% to 86.5%, p=0.02). Facility readiness increased in adequate staffing (56.7% to 98.3%, p<0.001), but decreased for equipment availability (98.3% to 90.0%, p=0.03). Overall, the proportion of facilities with all readiness components present increased from 0% to 63.3% (p<0.001).

Conclusions: We designed and implemented a supportive supervision strategy with strong implementation outcomes and most effectiveness outcomes including facility readiness to provide quality hypertension care in Nigeria. This approach can be modelled for supporting HEARTS implementation in other settings.

Trial registration number: The trial was prospectively registered at www.

Clinicaltrials: gov under NCT04158154 on 8 November 2019; https://clinicaltrials.gov/ct2/show/NCT04158154.

Keywords: CARDIOVASCULAR DISEASE; Global Health; Health services research.

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Conflict of interest statement

Competing interests: GLS and EO have received training support from Fogarty International Center (Award number: D43TW011976) through Cardiovascular Research Training in Nigeria (CeRTIN) and Northwestern University Chicago. MDH has received travel support from the World Heart Federation and consulting fees from PwC Switzerland. MDH has an appointment at The George Institute for Global Health, which has a patent, licence, and has received investment funding with intent to commercialise fixed-dose combination therapy through its social enterprise business, George Medicines. MDH has pending patents for heart failure preparation, review or decision or approval to submit this manuscript.

Figures

Figure 1
Figure 1. Distribution of supervision visits by proportion of core components completed.
See this image and copyright information in PMC

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