Haiti Community Health Workers (CHW) Adaptation

Phase

N/A

Condition

Congestive Heart Failure

Chest Pain

Heart Failure

Treatment

HF Standard of Care (SOC)

HF follow up care

Clinical Study ID

NCT05091710

H-41758

1K23HL140133-01A1

Ages > 18
All Genders

Study Summary

Evidence-based interventions to improve linkage and outcomes for heart failure (HF) patients requires input from stakeholders: patients, community health workers (CHWs), healthcare staff, and health system administrators.

In this research the investigators will assess a CHW intervention designed to improve linkage to care for HF patients. This intervention was systematically adapted for use in rural Haiti in a prior study using the Assessment, Decisions, Administration, Production, Topical Experts, Integration, Training staff, Testing (ADAPT-ITT) framework. The ADAPT-ITT framework provides 8 sequential phases to adapt interventions and programs to new target audiences. It has been applied successfully to the adaptation of several interventions for HIV among under-resourced communities leading to randomized clinical trials. With the first 6 steps of the ADAPT-ITT framework completed in a prior study, this protocol outlines the training and testing of the adapted CHW intervention.

In addition to assessing the feasibility, appropriateness, and acceptability of the adapted intervention through participants' feedback, the investigators will assess its efficacy in improving HF outcomes. The proposed intervention is targeted at both the patient domain - through improved peer support - and health system domain - by improving health system navigation.

Eligibility Criteria

Inclusion

Inclusion Criteria for patient participant:

Adult HF patients
Hospitalized >48 hours at Hôpital-Universitaire de Mirebalais (HUM)
Anticipated discharge from HUM within 1-3 days
Living in Mirebalais Commune, Haiti Inclusion criteria for historical patient reference group
Adult HF patients
Hospitalized >48 hours at HUM
Discharged from HUM within the 12 months preceding the intervention
Living in Mirebalais Commune

Exclusion Criteria for patient participant and historical patient reference group:

None

Inclusion Criteria for CHW

Adult
Provide inpatient or outpatient care to HF patients
Working in in Mirebalais

Exclusion Criteria for CHW

None

Inclusion criteria for healthcare staff (provider/administrator)

Hospital leadership involved in supervision of clinical care programs (i.e. Chief Executive Officer, Chief Medical Officer, Chief Operations Officer, Chief Nursing Officer, etc.)
Leaders of the Community Health Department - including the nurse Director of Community Health, and Community Health Worker Supervisors.
Healthcare providers at HUM involved in the care of patients with heart failure (i.e. internal medicine physicians, inpatient hospital nurses, outpatient clinic physicians, outpatient clinic nurses, etc.)

Exclusion criteria for healthcare staff (provider/administrator)

None

Study Design

HF Standard of Care (SOC)

February 23, 2023

August 31, 2025

Study Description

This is a clinical trial involving the training of 6 CHWs in a linkage-to-care intervention and the testing of the intervention on 30 HF patients. In a prior study, the ADAPT-ITT framework was used to adapt a CHW-based intervention for post-discharge HF patients in Haiti. This study represents the last two phases of the ADAPT-ITT framework: Training and Testing.

The study population will include adult HF patients (> 18 years of age), hospitalized for more than 48 hours, discharged from Hôpital-Universitaire de Mirebalais (HUM), without a prior clinic visit, living in Mirebalais Commune. Patients will be recruited for study participation shortly before discharge. A comparison group of 30 HF patients will be recruited and will not participate in the follow up care intervention. Those patients will be retrospectively identified from the medical record. The comparison group and will not receive any intervention. Six experienced CHWs will be trained to conduct the linkage to care intervention.

The intervention will include study visits in the form of home visits and phone calls performed by CHWs during which they will remind patients about upcoming visits, ensure patient has sufficient medications, review medication schedule and provide education as needed.

Connect with a study center

Zanmi Lasante/Hôpital Universitaire de Mirebalais
Mirebalais,
Haiti
Site Not Available
Zanmi Lasante/Hôpital Universitaire de Mirebalais
Mirebalais 3720811,
Haiti
Site Not Available

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