M318 Hypertension Improvement Program (HIP) in Haiti Draft Proposal

Transforming forgotten communities and providing hope through sustainable healthcare. HYPERTENSION IMPROVEMENT PROGRAM (HIP) in BALAN, HAITI PROGRAM PROPOSAL Serving Nord Region, Cap Haïtien, Haiti

OUR MISSION Mission:318 is a medical mission organization that exists to transform forgotten communities and provide hope through sustainable healthcare. We do this by combining the use of advanced technology, a strategic network of global partners, and trusted relationships in the neighborhoods we serve. OUR VISION To inspire hope to the vulnerable communities by providing care and medical mentorship. OUR VALUES Desiring to follow the model of our Lord and Savior Jesus Christ, we seek to: Love God. Love and serve others. Live as people of integrity. Strive for excellence. WWW.MISSION318.COM

EXECUTIVE SUMMARY Despite efforts by the World Health Organization to bring awareness to noncommunicable diseases, hypertension in low-and middle-income countries is increasing, leading to an increase in mortality from cardiovascular disease and stroke throughout these countries. In Haiti, lifestyle factors, inability to access clinical care and medications, lack of patient education, and extreme poverty all contribute to the untenable situation of hypertension control, and a disproportionate increase in morbidity and mortality from cardiovascular disease. The Hypertension Improvement Program (HIP) in Haiti is a culturally- sensitive, comprehensive care program for people with hypertension – focusing on the utilization of Community Health Workers (CHWs) to improve access to care and medications, community education programs, and hypertension care management. As the premier medical clinic in the Balan region, the CHIDA Medical Center and its staff will serve as the central hub for the project. Through collaboration, the HIP program intends to utilize the cultural and clinical strength of Community Health Workers and the clinical skills of the CHIDA medical staff to improve control of patients with hypertension. Mission:318, alongside CHIDA medical staff, will implement the HIP Program at CHIDA, prioritizing the incorporation of CHWs into the training programs, performing community-based blood pressure screenings along with patient education about hypertension control and lifestyle factors impacting high blood pressure, prescribe and distribute hypertension medications, and enroll patients in a hypertension management program with quarterly blood pressure checks. Over the course of three years, the HIP program aims to achieve four specific objectives; 1) the development of a training module for CHWs - focused on hypertension control and lifestyle and behavior modifications to reduce risk of cardiovascular disease, 2) the establishment of collaborative Hypertension Management Teams, 3) the identification and monitoring of patients with hypertension, and 4) the delivery of hypertension medications to patients in remote areas. Given the magnitude of adult Haitian with hypertension and limited access to quality care and medications CHWs are the key to reducing cardiovascular disease mortality in Haiti. The HIP program builds off the existing strength of the CHIDA-based CHW and their relationships with their communities. Educating CHW in hypertension management allows for a better understanding of current practices, available treatment options, and clinical indications for controlling hypertension. Through the involvement of stakeholders, the establishment of hypertension management practices, training of CHW, and education about hypertension, the HIP Program will impact preventable mortality from cardiovascular disease in Balan and the surrounding communities in Haiti. WWW.MISSION318.COM

VULNERABLE THE NEED COMMUNITY An opportunity exists to transform the lives Located in the Nord Region, near Cap of this vulnerable community by developing Haïtien, Haiti, the CHIDA Hospital serves a community-based hypertension program, the rural IDADEE community. This and improving access to medicines and population of approximately 60,000 diagnostics to improve clinical outcomes. suffers high rates of hypertension, Local leaders and health practitioners simply diabetes, HIV, and malaria - all need better infrastructure, technology, and contributing to poor maternal and child supplies to be able to improve health health outcomes. Additionally, a outcomes for mothers, children, and families resurgence in cholera has plagued this in the region. community, with 40% of recent hosptializations due to this disease. THE ASSESSMENT Mission:318 with its long-standing relationship with Brace for Impact46, the Pittsburgh Kids Foundation, and members of the IDADEE community recommend developing a a community-based hypertension program based on the HeartReach program and improving access to medicines and diagnostic technologies. By working with leadership of IDADEE, the CHIDA Medical Directors, local healthcare workers, as well as collaborating partners critical technology and supplies in order to expand accessibility, to provide educational materials, improve health outcomes, and ultimately transform the lives of the community. WWW.MISSION318.COM

HYPERTENSION IN HAITI Haiti is the sixth most populous country in North America, with a population of 11.7 million (2021). Haiti’s population is increasing at 1.2% per year, Haiti is a young country, with the average age of 24.1 years, with 54% of its population under 25 years of age. The average life expectancy in Haiti is 64 years of age (World Population Review, 2022). In Haiti, hypertension is the leading risk factor for cardiovascular disease, with an age adjusted prevalence of 28.5% in male adults between 35-64 (Lookens et al, 2020) and cardiovascular disease is the number one cause of death in Haiti. Hypertension in Haiti has a remarkably high prevalence and incidence of stroke or cerebrovascular incidence at 176 per 100,000, more than double than those in the Dominican Republic (Lavados, 2007). Hypertension is the number one risk factor for cardiovascular disease, the leading cause of preventable death in Haiti, above HIV, cholera, tuberculosis, and malaria combined. Some global health experts consider heart disease in Haiti as an epidemic. Hypertension in Haiti looks different than hypertension in the United States. One noted difference is that patients with high blood pressure were found to have higher levels of lead in their blood. The source of that lead could be from lead in the water, soil, cookware, or gasoline (Mbuthia et al, 2022). Poverty also contributes to blood pressure in Haiti – with most citizens earning less than $1 a day, eating nutritious foods like fruits and vegetable are often substituted for foods high in sugar, salt, and saturated fats – contributing to obesity and hypertension (Mbuthia et al, 2022). Additionally, the Haitian diet is high in salt and it is estimated that Haitians consume more than 9 times the recommended amount of daily salt recommended by the WHO (Mbuthia et al, 2022). These factors, along with limited access to clinical care, all contribute to high levels of uncontrolled hypertension in Haiti. WWW.MISSION318.COM

HYPERTENSION IMPROVEMENT PROGRAM Program Statement Mission:318, in collaboration with health professionals at the CHIDA Medical Clinic in Balan, Haiti intend to implement a program to control and reduce hypertension in the community. The Mission:318 program, Hypertension Improvement Program (HIP) in Haiti, intends to utilize, Community Healthcare Workers (CHW) from the CHIDA Medical Center, nurses from CHIDA, clinical specialists from Mission:318, and education specialists to identify patients with hypertension, educate patients, and ultimately control hypertension in communities in and around Balan, Haiti. Goal The aim of this program is to identify, treat and monitor patients with high blood pressure in the communities in and around Balan, Haiti. Additionally, to educate members of the Balan community on modifiable lifestyle behaviors to help reduce HTN. Objectives To increase number of controlled hypertension patients in Balan and surrounding communities and ultimately reduce adverse outcomes associated with hypertension, including morbidity and mortality from cardiovascular disease. Impact of Program An estimated 1 in 3 Haitian adults over 30 suspected of having hypertension, this program intends to control hypertension in patients in the surrounding communities of Balan. When high blood pressure is controlled, risk for death from cardiovascular disease and stroke is ultimately reduced. WWW.MISSION318.COM

HYPERTENSION IMPROVEMENT PROGRAM- THEORY OF CHANGE Hypertension For the purposes of this study, hypertension is defined as systolic blood presser greater than or equal to 140mmHgm diastolic blood pressure greater than 90mmHg, or use of an antihypertensive medication. Outcome The primary outcome of this study is mean change in systolic BP from baseline to 12 months Secondary outcomes include adequate BP control at 12 months and self-reported physical activity and dietary reports. All outcomes will be assessed at baseline, 6 months, 12 months 24 months and 36 months. WWW.MISSION318.COM

HIP IN HAITI -BUDGET The HIP Program in Haiti for the control of hypertension and hypertension management primarily involves training and deploying community health workers (CHWs) currently associated with the CHIDA Medical Clinic in Balan along with quarterly support from medical professionals at Mission:318. The three-year program is estimated at $186,000 USD, with the current exchange rate of 138.54 Haitian Gourde (HTG), equals approximately $2,5768,588.80 HTG. The table below categorizes the expenses for the HIP in Haiti program. Clinical professionals, medications, supplies and training comprise the majority of the budget. Costs associated for clinical program support include airfare, housing, food, security, and gratuities for medical professionals to travel to Haiti on a quarterly basis for education, training, and performing clinical evaluations while in Haiti. Clinical professionals will see approximately 300-500 patients per trip to Haiti. Training efforts will be focused on 34 CHWs, 2 community health nurses (CHN) – who will serve as in-country project managers. CHW and CHN will be provided food and a small stipend while training. By supplementing CHW wages, costs will be minimized but the community uptake of understanding the importance of controlling hypertension, and ultimately the risk of death from cardiovascular disease and stroke will be reduced. WWW.MISSION318.COM

HIP IN HAITI TIMELINE WWW.MISSION318.COM

TO DONATE TO MISSION:318 AND OUR HYPERTENSION IMPROVEMENT PROGRAM - HIP IN HAITI IN COLLABORATION AND PARTNERSHIP In Loving memory of Woudeline Louis [email protected] PO Box 372, Chesterfield, MO 63040 www.mission318.com +1 314 606 8745 Mission:318 MISSION318MEDICAL