Community vital signs (CVS): an integrated community-based approach to identify undiagnosed hypertension in nigeria

The National Heart, Lung, and Blood Institute awarded Oregon Health & Science University $2,141,996 on September 15, 2025, under the Cardiovascular Diseases Research program (CFDA 93.837) to develop and implement Community Vital Signs (CVS) strategies for identifying undiagnosed hypertension in Nigeria.

The project adapts community-based screening interventions to increase blood pressure screening among adults over 18 years of age and connect patients to primary care for hypertension management. CVS strategies leverage community-based screenings, digital technologies, and supportive care-linkage approaches through a practice-based research network of community clinics within the Nigeria Implementation Science Alliance's Model Innovation Research Centers. The project spans 12 community-based sites connected to 12 healthcare facilities across 12 Nigerian cities (two in each of Nigeria's six regions), with implementation guided by the RE-AIM and EPIS implementation science frameworks. The initial R61 phase (year one) engages stakeholders to refine CVS strategies and conduct implementation readiness assessments; the R33 phase (years two through five) implements and assesses the strategies across all 12 sites with approximately 24,000 participants.

Period of performance extends from September 15, 2025, through February 28, 2029. Work is performed in Portland, Oregon, with sub-recipients Kaiser Foundation Hospitals (awarded December 30, 2025) and University of Nigeria Nsukka (awarded October 31, 2025) contributing to implementation and research coordination in Nigeria.

Abstract

Hypertension (HTN) is a leading modifiable risk factor for global cardiovascular disease and stroke morbidity and mortality. Nigeria, africa's most populous country, has a high HTN burden. Evidence-based interventions (EBIS) for detection and initiation of treatment for HTN are not widely implemented in nigeria. These EBIS include widely available (1) BP screening (reaching all adults >18 years of age) to identify HTN early and (2) connections to ongoing primary care for HTN management. In partnership with community and clinical stakeholders, we are currently adapting community-based strategies shown to be effective in increasing HIV screening and connections to care. The proposed adapted strategies - called community vital signs (CVS) strategies - will utilize community-based screenings, digital technologies, and supportive approaches to connect people to healthcare facilities, leveraging our practice-based research network of community clinics within the model innovation research centers created by the nigeria implementation science alliance. We will use the RE-aim (reach, effectiveness, adoption, implementation, maintenance) and epis (exploratory, preparation, implementation, sustainment) implementation science frameworks to guide our work. Aim 1 / R61 phase (year 1): engage stakeholders to refine and finalize the CO-creation of CVS strategies aiming to increase rates of BP screening and connections to care in nigeria. By the end of the R61 phase, we will have final CVS strategies and will recruit, train, and conduct implementation readiness assessments at 12 community-based sites connected with 12 healthcare facilities in 12 nigerian cities (2 in each of nigeria's 6 regions). R33 phase (years 2-5) aim 2: implement and assess CVS strategies aiming to increase rates of BP screening at all 12 study sites (N=24,000 participants). We will initiate quarterly, community-based BP screenings and evaluate using RE-aim. Aim 3: implement and compare 2 different CVS strategies to make connections to primary care for those found to have high BP readings that meet HTN criteria at all study sites. We will conduct a nested, hybrid implementation-effectiveness type III trial using a parallel 2-arm cluster randomized design. Arm a (6 sites, N~3,000 participants): support connection to primary care by utilizing mhealth digital technologies with bidirectional sharing of BP data between community screening site and primary care clinic, coupled with a voucher for a medication starter kit (core strategies); arm B (6 sites, N~3,000 participants): core strategies plus community health navigators making handoffs to clinic and sending text messages (core+ strategies). This project promotes equitable access to HTN diagnosis and connections to care, especially in cities where HTN prevalence is highest. IT has the potential to significantly increase rates of early HTN detection and prevent the morbidity and mortality associated with the downstream effect of undiagnosed and uncontrolled HTN. IT will provide evidence for scale-up of interventions to support self- management of non-communicable chronic diseases in nigeria and other low- and middle-income countries.