Presentation (CTI)

OBJECTIVES: Hypertension is a major driver of cardiovascular morbidity in rural Northern Nigeria, where limited monitoring and poor adherence reduce treatment effectiveness. Digital health technologies (DHTs) offer promising patient-centered solutions, yet real-world evidence on their clinical and economic value in low-resource settings remains limited. The objective of this study is to evaluate real-world patient-centered, clinical, utilization, and economic outcomes associated with DHT-supported hypertension management in rural Northern Nigeria.
METHODS:
A mixed-methods study was conducted across six primary healthcare facilities in Gombe and northern Adamawa States (January-October 2025). A cohort of 482 hypertensive adults received Bluetooth-enabled home BP monitors linked with a mobile application and weekly SMS adherence reminders. Quantitative outcomes included BP control, Morisky adherence scores, healthcare utilization, and PROMIS Global Health measures. Costs were assessed using microcosting from patient and health-system perspectives. Qualitative data from interviews (n = 42) and focus groups (n = 6) explored usability, acceptability, and perceived value. Multilevel mixed-effects regression models examined associations between DHT use intensity and patient-centered outcomes. Ethical approval was obtained from relevant institutional review boards.
RESULTS: At 6 months, mean systolic BP decreased by 12.8 mmHg and diastolic BP by 7.3 mmHg (p < 0.001). High-intensity DHT users demonstrated greater medication adherence (aOR 1.82; 95% CI: 1.34-2.47) and 21% fewer unplanned clinic visits (p = 0.02). Patient-incurred costs (transport + productivity loss) declined by 34%. Per-patient implementation cost was US$18.60. Qualitative findings indicated high acceptability, improved self-efficacy, and enhanced autonomy in disease management, although network limitations and charging access posed challenges.
CONCLUSIONS: DHT-supported hypertension care produced meaningful improvements in patient-centered outcomes, adherence, clinical control, and economic efficiency. Findings provide robust real-world evidence supporting scalable integration of digital health solutions into rural primary care systems across low-resource regions.