After the November 2007 Nature article on the grand challenges in chronic noncommunicable diseases (NCDs),1 the Global Alliance for Chronic Diseases (GACD) was formed in 2009 by six of the world's largest public funders of health research.2 The first round of funding focused on hypertension, aligning with the World Health Organization's (WHO's) recognition that hypertension contributes to more deaths worldwide than any other single risk factor.3 The GACD funded 15 multiyear studies aimed at improving the awareness, prevention, treatment, and control of hypertension in low‐ and middle‐income countries (LMICs) and in aboriginal communities in Canada. Several studies employ elements of the WHO's Package of Essential Noncommunicable Disease Interventions for Primary Health Care in Low‐Resource Settings (WHO PEN), which is a framework tool within the WHO NCD Global Action Plan 2013–2020.4 The studies are variously implementing and evaluating innovations in technology, health service delivery, policy changes, and patient engagement in order to identify cost‐effective implementation strategies to improve the prevention and control of hypertension around the world.
The membership of the GACD has expanded from the original six health and medical research funding organizations in 2009 to its current 12 member agencies. The founding GACD funding member agencies in 2009 were the Canadian Institutes of Health Research (CIHR), Australia's National Health and Medical Research Council (NHM), the US National Institutes of Health, the United Kingdom Medical Research Council (MRC), the South African Medical Research Council (MRC), and the Indian Council of Medical Research (ICMR). Its overarching goals are three‐fold: coordination among member funding agencies, collaboration across research teams, and communication with policymakers. Funding agencies have been encouraged by the success of the GACD collaboration model, resulting in new members and funding for each research program. In 2014, member agencies committed over $30 million US dollars to the GACD Diabetes Program, which consists of 17 projects around the world, and a GACD Lung Diseases Program is being initiated in 2016.
Overview of GACD Hypertension Research Program
Hypertension was chosen by GACD as its inaugural funding priority in 2010, resulting in the GACD Hypertension Program with a total of $23 million US dollars in committed funds for 15 studies of up to 5 years’ duration. Coordinating peer‐reviewed funds within this program from both developed and developing countries, the GACD has demonstrated the viability of this new approach to funding research and the ability to coordinate international efforts in the prevention and control of NCDs. Isolated studies are limited in their ability to generate scalable evidence for tackling complex issues. The extensive interaction and exchange of information among GACD network researchers has unlocked great potential to generate new evidence to influence policy and practice and to build research capacity in LMICs. A central tenet of the GACD has been the emphasis on using the latest implementation science approaches, and pairing high‐ and low‐income country partners. Interventions are carefully culturally tailored to LMIC study settings, populations, and contexts as well as designed to engage local and national policymakers at all stages of project development, implementation, and evaluation. The aims and objectives of the Hypertension Program are summarized in the Table. The researchers for each program are listed in the Appendix.
Table 1.
Principles and Objectives of Global Alliance for Chronic Diseases Research Programs
| Research Principles |
|
| Overall Aims |
|
The GACD Hypertension Program includes a network of researchers from 19 countries. Six projects are being undertaken in Africa (Ghana, Kenya, Nigeria, Rwanda, South Africa, Tanzania, and Uganda), three in South Asian countries, and three in a number of locations within India and are working in a number of different locations throughout that country. There is also a project being conducted in the Pacific Islands of Fiji and Samoa, as well as three projects in South America (Argentina, Colombia, and Peru), one in aboriginal communities in Canada, and one in China and in Malaysia. In all, more than 100,000 participants are being surveyed and screened with an overall goal to recruit more than 25,000 patients with hypertension into various trials of preventive and/or clinical interventions. The majority of projects (13 in total) are randomized pragmatic clinical trials. Other projects involve population‐based surveys and a preintervention and postintervention population assessment. Standardized definitions for hypertension are being used (blood pressure ≥140/90 mm Hg or being treated for hypertension), with two studies also including a lower threshold (≥130/80 mm Hg) for people with diabetes. One study in China involves primary school children and their families; the remainder of the studies are enrolling only adults (18 years and older). The studies are a combination of pragmatic effectiveness and/or proof‐of‐concept trials involving heterogeneous study populations, hence the focus on maximizing external validity to maintain the generalizability of study findings. Secondary studies include barriers and facilitators to the provision of care, as well as studies of supporting policies and regulatory frameworks.
Each study has identified innovative intervention strategies including the use of short message service (SMS) text messaging, “smart phone” technologies, child‐to‐adult education for sodium reduction, policy interventions, and task‐shifting. Task‐shifting includes the rational redistribution of tasks among the health workforce to make more efficient use of human resources. In addition, most projects emphasize sustainability, ongoing knowledge engagement with relevant local stakeholders and end‐users, and the potential for future implementation and scale‐up.
The research principles and overall aims of the GACD Hypertension Program have been shaped to address the needs of the local context and to generate lessons, approaches, and results that can be more widely implemented and generalized to other settings and contexts. Through the annual scientific meeting, the research teams have developed into a global research community, in turn strengthening the individual research projects. Several researcher‐initiated, cross‐project working groups on different topics have been established to facilitate the opportunities to regularly exchange and interact. The Annual Scientific Meetings (ASM) hosted by different GACD member agencies are convened to facilitate the learnings and joint activities of all teams. This includes capacity development workshops on implementation science. Development of a core set of consensus measures across the program will enable cross‐site data analysis and comparisons in line with the implementation research agenda of the GACD.5 These studies fit in with the WHO's Global Monitoring Framework for NCDs for blood pressure control and dietary sodium reduction. Through a researcher‐initiated, process evaluation working group, each team is being encouraged to conduct and publish a process evaluation in order to facilitate wider implementation and appropriate adaptation and refinement of programs in the future.
In conclusion, the GACD Hypertension Program is undertaking important research to improve hypertension awareness, prevention, treatment, and control, and to maintain normal blood pressure levels in healthy people at risk for hypertension in vulnerable populations around the world. In the coming years, the findings from these studies will help policymakers and healthcare payers to better manage the emerging global NCD epidemic. Hopefully, this new approach will facilitate the development of cost‐effective, evidence‐based guidelines and policies leading to the control of hypertension in LMICs, which bear the largest burden of hypertension and its complications globally.
Disclosures
This work was supported by the Global Alliance for Chronic Disease and all of the listed national peer‐review funding agencies. The authors report no other conflicts.
Acknowledgments
The writing group would like to thank the GACD Secretariat staff for invaluable logistical, administrative, and analytical support. They would also like to thank all members of the GACD Hypertension Research Programme for their support and input throughout the preparation of this manuscript. Funding for the studies described and for manuscript submission was provided by the GACD Hypertension Programme funding agencies—Canadian Institutes of Health Research; Grand Challenges Canada; International Development Research Centre; Canadian Stroke Network; Australian National Health and Medical Research Council; the US National Institutes of Health (NIH; National Heart, Lung, and Blood Institute and National Institute of Neurological Disorders and Stroke [NINDS]); the United Kingdom Medical Research Council; and the South African Medical Research Council. This report does not represent the official view of the NINDS, the NIH, or any part of the US federal government. No official support or endorsement of this article by the NINDS or NIH is intended or should be inferred.
Hypertension Research Programme members (listed in alphabetical order for each team)
Team 1
Amir Attaran, University of Ottawa, Ottawa, Canada.
Anniza de Villiers, South African Medical Research Council, Cape Town, South Africa.
Amber Featherstone, Mildmay Uganda, Lweza, Uganda.
Jamie Forrest, Global Evaluative Sciences, Vancouver, Canada.
Robert Kalyesubula, Makerere University, Kampala, Uganda.
Julius Kamwesiga, IntraHealth Rwanda, Kigali, Rwanda.
Andre P. Kengne, South African Medical Research Council, Cape Town, South Africa.
Paul Camacho Lopez, Universidad Autonoma de Bucaramanga, Bucaramanga, Colombia.
Edward Mills, University of Ottawa, Ottawa, Canada.
Barbara Mukasa, Mildmay Uganda, Lweza.
Katherine Muldoon, University of Ottawa, Ottawa, Canada.
Jean‐Claude Tayari, Rwanda Ministry of Health, Kigali, Rwanda.
Sanni Yaya, University of Ottawa, Ottawa, Canada.
Team 2
Ng Kien Keat, Universiti Teknologi Mara, Selangor, Malaysia.
Patricio Lopez, Universidad de Santander, Bucaramanga, Colombia.
Juan Lopez Casas, Instituto Nacional de Salud, Bogota, Colombia.
Tara McCready, Population Health Research Institute, Hamilton, Canada.
Martin McKee, London School of Hygiene and Tropical Medicine, London, UK.
Eleanor Ng, Population Health Research Institute, Hamilton, Canada.
Robby Nieuwlaat, McMaster University, Hamilton, Canada.
Ariffin Omar Zainal, Ministry of Health, Putrajaya, Malaysia.
Khalid Yusoff, Universiti Teknologi Mara, Selangor, Malaysia.
Salim Yusuf, McMaster University and Population Health Research Institute, Hamilton, Canada.
Team 3
Norman Campbell, Libin Cardiovascular Institute of Alberta, Calgary, Canada.
Kajiru Kilonzo, Kilimanjaro Christian Medical College, Moshi, Tanzania.
Peter Liu, University of Ottawa Heart Institute, Ottawa, Canada.
Marion Marr, Northern Ontario School of Medicine, Sudbury, Canada.
Sheldon Tobe, Sunnybrook Health Sciences Centre, Toronto, Canada.
Karen Yeates, Queen's University School of Medicine, Kingston, Canada.
Team 4
Xiangxian Feng, Changzhi Medical College, Shanxi, China.
Feng He, Queen Mary University of London, London, UK.
Stephen Jan, The George Institute for Global Health, Sydney, Australia.
Xian Li, The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
Ching‐Ping Lin, The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
Jun Ma, Peking University Health Science Center, Beijing, China.
Yuan Ma, Peking University School of Public Health, Beijing, China.
Graham MacGregor, Queen Mary University of London, London, UK.
Caryl Nowson, Deakin University, Melbourne, Australia.
Haijun Wang, Peking University Health Science Center, Beijing, China.
Yangfeng Wu, The George Institute for Global Health at Peking University Health Science Center, Beijing.
Lijing Yan, The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
Jianhui Yuan, Changzhi Medical College, Shanxi, China.
Jing Zhang, The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
Team 5
Jane Goudge, University of the Witwatersrand, Johannesburg, South Africa.
Chodziwadziwa Kabudula, University of the Witwatersrand, Johannesburg, South Africa.
Felix Limbani, University of the Witwatersrand, Johannesburg, South Africa.
Nkosinathi Masilela, University of the Witwatersrand, Johannesburg, South Africa.
Nokuzola Myakayaka, University of the Witwatersrand, Johannesburg, South Africa.
Margaret Thorogood, University of Warwick, Coventry, UK, and University of the Witswatersrand, Johannesburg, South Africa.
Francesc Xavier Gómez‐Olivé, University of the Witwatersrand, Johannesburg, South Africa.
Team 6
Simin Arabshahi, Monash University, Melbourne, Australia.
Clara Chow, The George Institute for Global Health, Sydney, Australia.
Roger Evans, Monash University, Melbourne, Australia.
Rohina Joshi, The George Institute for Global Health, Sydney, Australia.
Kartik Kalyanram, Rishi Valley Education Centre – Rural Health, Andhra Pradesh, India.
Kamakshi Kartik, Rishi Valley Education Centre – Rural Health, Andhra Pradesh, India.
Ajay Mahal, Monash University, Melbourne, Australia.
Pallab Maulik, The George Institute for Global Health, New Delhi, India.
Brian Oldenburg, Monash University, Melbourne, Australia.
Michaela Riddell, Monash University, Melbourne, Australia.
Velandai Srikanth, Monash University, Melbourne, Australia.
Oduru Suresh, Rishi Valley Education Centre – Rural Health, Andhra Pradesh, India.
Kavumpurathu Thankappan, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India.
Sathish Thirunavukkarasu, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India.
Nihal Thomas, Christian Medical College Vellore, Vellore, India.
Amanda G. Thrift, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
Ravi Varma, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India.
Team 7
Gari Clifford, Emory University, Atlanta, USA.
Stephane Heritier, Monash University, Melbourne, Australia.
Stephen Jan, The George Institute for Global Health, University of Sydney, Australia.
Rohina Joshi, The George Institute for Global Health, University of Sydney, Australia.
Stephen MacMahon, The George Institute for Global Health, University of Sydney, Australia.
Pallab Maulik, The George Institute for Global Health, New Delhi, India.
Anushka Patel, The George Institute for Global Health, University of Sydney, Australia.
David Peiris, The George Institute for Global Health, University of Sydney, Australia.
Dorairaj Prabhakaran, Public Health Foundation of India and Centre for Chronic Disease Control, New Delhi, India.
Devarsetty Praveen, The George Institute for Global Health, Hyderabad, India.
Team 8
Stephen Jan, The George Institute for Global Health, University of Sydney, Australia.
Pallab Maulik, The George Institute for Global Health, New Delhi, India.
Anushka Patel, The George Institute for Global Health, University of Sydney, Australia.
Dorairaj Prabhakaran, Public Health Foundation of India and Centre for Chronic Disease Control, New Delhi, India.
Anthony Rodgers, The George Institute for Global Health, University of Sydney, Australia.
Abdul Salam, The George Institute for Global Health, New Delhi, India.
Simon Thom, Imperial College London, London, UK.
Ruth Webster, The George Institute for Global Health, University of Sydney, Australia.
Team 9
Claire Johnson, The George Institute for Global Health, Sydney, Australia.
Anand Krishnan, All India Institute of Medical Sciences, New Delhi, India.
Sailesh Mohan, Public Health Foundation of India, New Delhi, India.
Bruce Neal, The George Institute for Global Health, Sydney, Australia.
Dorairaj Prabhakaran, Public Health Foundation of India and Centre for Chronic Disease Control, New Delhi, India.
K Srinath Reddy, Public Health Foundation of India, New Delhi, India.
Roopa Shivashankar, Public Health Foundation of India and Centre for Chronic Disease Control, New Delhi, India.
Thout Sudhir, The George Institute for Global Health, New Delhi, India.
Team 10
Sarah Faletoese, Samoan Ministry of Health, Apia, Samoa.
Merina Ieremia, Samoan Ministry of Health, Apia, Samoa.
Marj Moodie, Deakin University, Melbourne, Australia.
Bruce Neal, The George Institute for Global Health, Sydney, Australia.
Arti Pillay, Pacific Research Centre for the Prevention of Obesity and Non‐communicable Diseases, Suva, Fiji.
Jimaima Schultz, National Food and Nutrition Centre, Suva, Fiji.
Junior Siitia, Samoan Ministry of Health, Apia, Samoa.
Wendy Snowdon, World Health Organization, Suva, Fiji.
Arleen Sukhu, Pacific Research Centre for the Prevention of Obesity and Non‐communicable Diseases, Suva, Fiji.
Christina Ulberg, Samoan Ministry of Health, Apia, Samoa.
Satupaitea Viali, Samoan Ministry of Health, Apia, Samoa.
Jacqui Webster, The George Institute for Global Health, Sydney, Australia.
Team 11
Antonio Bernabe‐Ortiz, Universidad Peruana Cayetano Heredia, Lima, Peru.
María Kathia Cárdenas, Universidad Peruana Cayetano Heredia, Lima, Peru.
Francisco Diez‐Canseco, Universidad Peruana Cayetano Heredia, Lima, Peru.
Robert H. Gilman, Johns Hopkins University, Baltimore, USA.
J. Jaime Miranda, Universidad Peruana Cayetano Heredia, Lima, Peru.
Vilarmina Ponce‐Lucero, Universidad Peruana Cayetano Heredia, Lima, Peru.
Katherine Sacksteder, Johns Hopkins University, Baltimore, USA.
Team 12
Kingsley Apusiga, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Richard Cooper, Loyola University Chicago Stritch School of Medicine, Maywood, USA.
Joyce Gyamfi, New York University School of Medicine, New York, USA.
Michael Ntim, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Olugbenga Ogedegbe, New York University School of Medicine, New York, USA.
Jacob Plange‐Rhule, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Team 13
Cynthia Binanay, Duke University, Durham, USA.
Gerald Bloomfield, Duke University, Durham, USA.
Allison DeLong, Brown University, Providence, USA.
Eric Finkelstein, Duke University – Singapore, Singapore, Singapore.
Valentin Fuster, Icahn School of Medicine at Mount Sinai, New York, USA.
Joseph Hogan, Brown University, Providence, USA.
Jemima Hoine Kamano, Moi University, Eldoret, Kenya.
Carol Horowitz, Icahn School of Medicine at Mount Sinai, New York, USA.
Tom Inui, Indiana University, Indianapolis, USA.
Sylvester Kimaiyo, Moi University, Eldoret, Kenya.
Claire Kofler, Icahn School of Medicine at Mount Sinai, New York, USA.
Diana Menya, Moi University, Eldoret, Kenya.
Violet Naanyu, Moi University, Eldoret, Kenya.
Jackson Rotich, Moi University, Eldoret, Kenya.
Rajesh Vedanthan, Icahn School of Medicine at Mount Sinai, New York, USA.
Eric Velazquez, Duke University, Durham, USA.
Martin Were, Indiana University, Indianapolis, USA.
Team 14
Federico Augustovski, Institute for Clinical Effectiveness and Heath Policy, Buenos Aires, Argentina.
Andrea Beratarrechea, Institute for Clinical Effectiveness and Heath Policy, Buenos Aires, Argentina.
Jing Chen, Tulane University, New Orleans, USA.
Jacquelyn Dolan, Tulane University, New Orleans, USA.
Jiang He, Tulane University, New Orleans, USA.
Vilma Irazola, Institute for Clinical Effectiveness and Heath Policy, Buenos Aires, Argentina.
Marie Krousel‐Wood, Tulane University, New Orleans, USA.
Katherine Mills, Tulane University, New Orleans, USA.
Rosana Poggio, Institute for Clinical Effectiveness and Heath Policy, Buenos Aires, Argentina.
Adolfo Rubinstein, Institute for Clinical Effectiveness and Heath Policy, Buenos Aires, Argentina.
Lizheng Shi, Tulane University, New Orleans, USA.
Larry Webber, Tulane University, New Orleans, USA.
Team 15
Rufus Akinyemi, Federal Medical Center, Abeokuta, Nigeria.
Oyedunni Arulogun, University of Ibadan, Ibadan, Nigeria.
Mulugeta Gebregziabher, Medical University of South Carolina, Charleston, USA.
Samantha Hurst, University of California San Diego, San Diego, USA.
Bruce Ovbiagele, Medical University of South Carolina, Charleston, USA.
Mayowa Owolabi, University of Ibadan, Ibadan, Nigeria.
Ezinne Uvere, University Hospital, Lagos, Nigeria.
Salina Waddy, National Institute of Health, Bethesda, USA.
Stephanie Warth, Medical University of South Carolina, Charleston, USA.
Contributor Information
the Global Alliance for Chronic Diseases Hypertension Research Teams With the World Hypertension League:
Amir Attaran, Anniza de Villiers, Amber Featherstone, Jamie Forrest, Robert Kalyesubula, Julius Kamwesiga, Andre P. Kengne, Paul Camacho Lopez, Edward Mills, Barbara Mukasa, Katherine Muldoon, Jean‐Claude Tayari, Sanni Yaya, Ng Kien Keat, Patricio Lopez, Juan Lopez Casas, Tara McCready, Martin McKee, Eleanor Ng, Robby Nieuwlaat, Ariffin Omar Zainal, Khalid Yusoff, Salim Yusuf, Norman Campbell, Kajiru Kilonzo, Peter Liu, Marion Marr, Karen Yeates, Xiangxian Feng, Feng He, Stephen Jan, Xian Li, Ching‐Ping Lin, Jun Ma, Yuan Ma, Graham MacGregor, Caryl Nowson, Haijun Wang, Yangfeng Wu, Lijing Yan, Jianhui Yuan, Jing Zhang, Jane Goudge, Chodziwadziwa Kabudula, Felix Limbani, Nkosinathi Masilela, Nokuzola Myakayaka, Margaret Thorogood, Francesc Xavier Gómez‐Olivé, Simin Arabshahi, Clara Chow, Roger Evans, Rohina Joshi, Kartik Kalyanram, Kamakshi Kartik, Ajay Mahal, Pallab Maulik, Brian Oldenburg, Michaela Riddell, Velandai Srikanth, Oduru Suresh, Kavumpurathu Thankappan, Sathish Thirunavukkarasu, Nihal Thomas, Amanda G. Thrift, Ravi Varma, Gari Clifford, Stephane Heritier, Stephen Jan, Rohina Joshi, Stephen MacMahon, Pallab Maulik, Anushka Patel, David Peiris, Dorairaj Prabhakaran, Devarsetty Praveen, Stephen Jan, Pallab Maulik, Anushka Patel, Dorairaj Prabhakaran, Anthony Rodgers, Abdul Salam, Simon Thom, Ruth Webster, Claire Johnson, Anand Krishnan, Sailesh Mohan, Bruce Neal, Dorairaj Prabhakaran, K Srinath Reddy, Roopa Shivashankar, Thout Sudhir, Sarah Faletoese, Merina Ieremia, Marj Moodie, Bruce Neal, Arti Pillay, Jimaima Schultz, Junior Siitia, Wendy Snowdon, Arleen Sukhu, Christina Ulberg, Satupaitea Viali, Jacqui Webster, Antonio Bernabe‐Ortiz, María Kathia Cárdenas, Francisco Diez‐Canseco, Robert H. Gilman, J. Jaime Miranda, Vilarmina Ponce‐Lucero, Katherine Sacksteder, Kingsley Apusiga, Richard Cooper, Joyce Gyamfi, Michael Ntim, Olugbenga Ogedegbe, Jacob Plange‐Rhule, Cynthia Binanay, Gerald Bloomfield, Allison DeLong, Eric Finkelstein, Valentin Fuster, Joseph Hogan, Jemima Hoine Kamano, Carol Horowitz, Tom Inui, Sylvester Kimaiyo, Claire Kofler, Diana Menya, Violet Naanyu, Jackson Rotich, Rajesh Vedanthan, Eric Velazquez, Martin Were, Federico Augustovski, Andrea Beratarrechea, Jing Chen, Jacquelyn Dolan, Jiang He, Vilma Irazola, Marie Krousel‐Wood, Katherine Mills, Rosana Poggio, Adolfo Rubinstein, Lizheng Shi, Larry Webber, Rufus Akinyemi, Oyedunni Arulogun, Mulugeta Gebregziabher, Samantha Hurst, Bruce Ovbiagele, Mayowa Owolabi, Ezinne Uvere, Salina Waddy, and Stephanie Warth
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