1016- Peru- ANDES: Addressing Hypertension and Diabetes through Community Engaged Systems

The overall objective of ANDES is to evaluate the effectiveness of a home-based community health worker (CHW)-led intervention in reducing blood pressure and improving hypertension control in patients from under-resourced communities in Puno, Peru.

ANDES study participants are being identified, screened, and recruited via 2 different mechanisms: 1) community health fairs and 2) healthcare facility-based enrollment. Potential participants are screened for blood pressure measurements and type 2 diabetes (HbA1c). Recruitment is rolling over 24 months during which a total of 1068 participants will be enrolled, 534 assigned to the intervention arm and 534 to a control arm. Participants in the control arm are referred to their local healthcare facility for evaluation and/or to receive medical therapy per typical standard of care and at the discretion of the treating physician for the entirety of the ANDES study. Participants in the intervention arm receive monthly CHW home visits for 12 consecutive months. After month 12, intervention participants will be advised to obtain standard care from their local healthcare facility. The primary outcome is to determine if ANDES participants randomized to the intervention arm have an average reduction in SBP of at least 2.5 mmHg relative to the usual care arm 12 months after randomization. As secondary outcomes, we are also assessing changes in diet, physical activity, quality of life, treatment adherence, mental health, sleep, and tobacco/alcohol consumption as a result of our intervention. Study outcome measures will be obtained in both the usual care (control) and ANDES intervention arms at baseline and months 12 and 18 post-randomization.

The student will primarily support one or both of the following study components, based on interest and expertise: 1) determining the impact of air pollution exposure on blood pressure, and 2) conducting qualitative interviews to understand factors influencing acceptability and effectiveness of the CHW intervention. The student would be responsible for supporting day to day activities in Puno and ensuring that these study components are carried out according to the study protocol and milestones. The student would help troubleshoot issues that arise related to field activities, conduct data collection visits, and assist the data managers with data quality checks and data cleaning. Tasks may include but are not limited to the following:

• Assist in training and overseeing daily activities of field staff
• Accompany field staff on household visits to support and oversee data collection
• Assist field staff in installing equipment, obtaining health measurements, completing surveys, and conducting in-depth interviews with participants
• Carry out routine data cleaning and work closely with the data manager to build local data management capacity
• Compile updates for weekly reports on visits and activities completed
• Participate in weekly meetings with the local and JHU team and assist with documenting key decisions and follow-up actions
• Conduct preliminary statistical analyses on the association between air pollution exposure and blood pressure and/or conduct preliminary qualitative analysis of patient and CHW interviews
• Contribute to reports and manuscripts on the study findings

The Puno team exemplifies a culture of collaboration and respect in a casual atmosphere. They are diligent and team-oriented. Their open-mindedness is evident, and they actively engage in both learning from others and sharing their experiences to educate their peers. The team promotes a supportive and inclusive atmosphere. The student will also be supported by an established infrastructure of research in Puno where various other projects are currently ongoing. The student will be able to form a community with other students and researchers (both from Peru and the US) working on ANDES as well as other projects in Puno. The student will also be supported by a team of researchers and students, including Dr. William Checkley and Dr. Laura Nicolaou, who will provide additional mentorship and guidance.

This position is ideal for someone with a keen interest in environmental health, chronic disease research, and/or qualitative research. It offers the unique chance to learn how to conduct exposure and health monitoring and/or qualitative interviewing within the context of a randomized control trial. The ideal student would have a proactive and independent work ethic with a collaborative spirit. We are looking for someone with a desire to gain on-the-ground experience carrying out research in an LMIC context and willing to collaborate with a supportive and open-minded team of local staff who are eager to learn and share experiences.

Name: Kendra Williams, Department of International Health, kendra.williams@jhu.edu

I would describe my communication and mentorship styles as... 

I believe in open communication and ensuring my mentees feel comfortable sharing experiences, asking questions, and seeking guidance. I strive to help students set appropriate goals and provide constructive feedback to help them achieve those goals. I always make myself accessible through regular meetings, email, or phone communications. I ensure mentees can be independent while providing appropriate encouragement, motivation, and support. The student will also be working closely with a team of other researchers and students who will also provide additional mentorship and guidance.

A complementary student would have a working style and mentorship expectations that are..

The ideal student would have a proactive and independent working style. They should be self-motivated and willing to take initiative, while ensuring responsiveness and regular communication with their mentor and other team members.

Housing will be provided in the student quarters of the study site office. Puno is a small town and most places can be reached on foot or in short taxi rides that cost ~$2-3. There is a kitchen available at the office where students can cook. For lunches, various restaurants around town are open for “menu” (choice between several lunch options) that costs around ~$2-3. Nicer restaurants are also available where a meal costs ~$10-20.