Health insurance coverage with or without a nurse-led task shifting strategy for hypertension control: a pragmatic cluster randomized trial in Ghana

Rationale: Poor access to care and physician shortage are major barriers to hypertension control in sub-Saharan Africa. Implementation of evidence-based systems-level strategies targeted at these barriers are lacking. Objective: To evaluate the comparative effectiveness of provision of health insurance coverage (HIC) alone versus a nurse-led task-shifting strategy for hypertension control (TASSH) plus HIC on systolic BP reduction among patients with uncontrolled hypertension in Ghana. Methods and Findings: Using a pragmatic cluster-randomized trial, 32 community health centers within Ghana's public healthcare system were randomly assigned to either HIC alone or TASSH+HIC. A total of 757 patients with uncontrolled hypertension were recruited between November 28 2012 and June 11 2014 and followed up to October 7 2016. Both intervention groups received health insurance coverage plus scheduled nurse visits while TASSH+HIC comprised cardiovascular risk assessment; lifestyle counseling, and i...