Lay Community Health Worker Care With Mobile Decision Support

Key Takeaways

• Higher blood pressure control was observed with community health worker care supported by mobile decision tools than with referral-based facility care.
• No relevant differences in safety outcomes were observed between the study groups.
• Trial registration and linked data, statistical code, and application code resources were made publicly available.

In rural Lesotho, lay community health worker care supported by mobile decision tools achieved 12-month blood pressure control in 58% of participants, versus 48% with referral-based facility care. T In a remote, resource-limited setting, investigators conducted a cluster-randomized trial in rural Lesotho with 1:1 allocation within the Community-Based Chronic Care Lesotho cohort. Community-based screening preceded enrollment across 103 rural villages. The trial enrolled 547 nonpregnant adults whose blood pressure measured at least 140/90 mm Hg, with 274 participants in control clusters and 273 in intervention clusters. In intervention clusters, lay community health workers independently prescribed and titrated a fixed-dose combination of amlodipine and hydrochlorothiazide with guidance from a mobile clinical decision support system. Control clusters referred participants to health facilities for standard care.

The prespecified primary outcome was blood pressure below 140/90 mm Hg at 12 months. The intention-to-treat analysis included 543 participants after 4 exclusions owing to intercurrent pregnancy. Blood pressure control was achieved by 156 of 271 participants in the intervention arm and 130 of 272 in the control arm, corresponding to 58% and 48%, respectively, with an adjusted odds ratio of 1.52, a 95% confidence interval of 1.01 to 2.29, and P=0.046. The absolute difference favored the intervention group. A predefined complete-case analysis was consistent with the main result.

No relevant differences in safety outcomes were observed between the study groups. The authors said these findings support expanding first-line hypertension management by lay community health workers in remote, resource-limited settings.