Table 3.

Implementation outcomes for Hypertension Treatment in Nigeria Program

RE-AIM Domain: Definition	Level	Type	Outcome
Reach: Absolute number, proportion, and representativeness of sites and individuals who participate in the HTN Program	Program	Quantitative	• Number of participating PHCs/total number of selected PHCs in the Federal Capital Territory
	Center	Quantitative	• Diversity of participating PHCs and staff in terms of size, ward, baseline staffing levels
		Qualitative	• Reasons for non-participation of selected PHCs in the Federal Capital Territory • Reasons for adult patients to have not been screened for high BP within participating PHCs within the past 3 working days
	Individual	Quantitative	• Number of adult patients with BPs measured / total number of adult patients within participating PHCs within the past 3 working days • Differences in sociodemographic (e.g., age, sex, geography) characteristics between registered patients and individuals in the clinic catchment areas based on concurrently collected or community-based survey data • Diversity of registered patients receiving care at participating PHCs for HTN diagnosis and management by age, sex, ward, and education
Effectiveness: The impact of the HTN Program on treatment and control rates	Program	Quantitative	• Treatment rate within the overall system of participating PHCs defined by 6-month rolling average • Control rate within the overall system of participating PHCs defined by 6-month rolling average • Mean systolic blood pressure and diastolic blood pressure within the overall system of participating PHCs defined by 6-month rolling average and based on last visit
	Center	Quantitative	• Median and/or mean treatment rate across participating PHCs defined by 6-month rolling average • Median and/or mean control rate across participating PHCs defined by 6-month rolling average • Mean SBP and DBP across participating PHCs defined by 6-month rolling average and based on last visit
		Qualitative	• Reasons for variation in treatment rates between participating PHCs • Reasons for variation in control rates between participating PHCs • Reasons for variation in mean systolic and diastolic blood pressure between participating PHCs
Adoption: Absolute number, proportion, and representativeness of sites who are willing to initiate the HTN Program	Program	Quantitative	• Percentage of PHCs using the hypertension patient registry in the last 3 months • Percentage of patients treated with fixed-dose combination therapies in the last 3 months
		Qualitative	• Reasons for variation in registry use among participating PHCs at 3 months after site initiation • Reasons for variation in use of fixed-dose combination therapies in the last 3 months • Adoption of team-based care among participating PHCs, and reasons for success or challenges
Implementation: Fidelity to the HTN Program protocol, including consistency of delivery as intended. Time and cost of the intervention, and use of the intervention strategies	Program	Quantitative	Fidelity (Implementation) • Proportion of selected PHCs who participated in baseline hypertension training • Proportion of selected PHCs who participated in site initiation training • Proportion of selected PHCs who received at least one supportive supervision visit in the past 7 months • Proportion of selected PHCs who received an audit and feedback report within the past 3 months • Percentage of PHCs with a working blood pressure monitor at the site on the day of assessment • Percentage of PHCs with blood pressure medicines available on the day of assessment • Percentage of patients with step up indicated who received step up treatment in the last 6 months Cost • Modeled direct HTN Program costs based on staff, BP machines, data capture, data analysis, and BP lowering drugs for hypertension diagnosis, treatment and control overall, for each PHC and per patient
	Program	Qualitative	Fidelity (Implementation) • Reasons for variation in fidelity measures • Reasons for variation in availability of essentials medicines and equipment • Reasons for variation in fidelity to the step up treatment protocol Cost • Acceptability of upfront and ongoing HTN Program costs among stakeholders, including within Federal Ministry of Health
	Center	Quantitative	Fidelity (Intervention) • Number and proportion of adult patients with hypertension who are registered/total number of adult patients with elevated blood pressure within participating PHCs within the past 3 working days • Monthly proportion of registered patients with appropriate stepped care/total number of registered patients • Monthly proportion of registered patients treated with fixed-dose combination therapy/total number of patients on treatment
	Center, Individual	Qualitative	Fidelity (Implementation) • Reasons for adult patients with hypertension to have not been registered within participating PHCs within the past 3 working days
	Individual	Quantitative	Cost • Modeled monthly and annual out-of-pocket drug costs for hypertension treatment
	Individual	Qualitative	Acceptability • Reasons for variation in acceptability, satisfaction, and perceived quality of care at patient-level • Trust in primary health care system Cost • Acceptability of upfront and ongoing hypertension diagnosis and treatment costs among patients with hypertension
Maintenance: The extent to which the HTN Program becomes institutionalized or part of the routine organizational practice	Center	Quantitative	Maintenance • Proportion of participating PHCs who maintain treatment rates above baseline rates at 6, 12, 24, 36, and 48 months • Proportion of participating PHCs who maintain control rates above baseline rates at 6, 12, 24, 36, and 48 months • Proportion of participating PHCs without blood pressure medication stockouts at 36 and 48 months • Proportion of participants retained in care at participating PHCs at 6, 12, 24, 36, and 48 months
		Qualitative	Maintenance • Reasons for variation in maintenance of treatment rates above baseline rates • Reasons for variation in maintenance of control rates above baseline rates • Reasons for variation in sustainment of blood pressure medication supplies • Reasons for variation in proportion of participants retained in care at PHCs
	Individual	Qualitative	Maintenance • Reasons for remaining in care and on treatment within the PHC

Abbreviations: BP Blood pressure, HTN Hypertension Treatment in Nigeria, PHC Primary health care center