NCT05524987: ANDES

Addressing HyperteNsion and Diabetes Through Community-Engaged Systems in Puno, Peru (ANDES Study)

Active, enrolled NA Last updated 19 August 2025

What this trial tests

NA trial testing ANDES INTERVENTION in Hypertension in 1,068 participants. Participants enrolled and being followed up; not accepting new ones.

Timeline

20 March 2023

Primary endpoint
31 March 2026

30 September 2026

Quick facts

Lead sponsor	Universidad Peruana Cayetano Heredia
Phase	NA
Status	Active, enrolled
Study type	INTERVENTIONAL
Allocation	randomized
Design	parallel
Masking	double
Primary purpose	health services research
Enrollment	1,068
Start date	20 March 2023
Primary completion	31 March 2026
Estimated completion	30 September 2026
Sites	1 location across Peru

Drugs / interventions tested

• ANDES INTERVENTION

Conditions studied

• Hypertension — all drugs for Hypertension →
• Diabetes — all drugs for Diabetes →

Sponsor

Universidad Peruana Cayetano Heredia — full company profile →

Who can join

18 and older, any sex, with Hypertension or Diabetes. Patients with the condition only — healthy volunteers not accepted.

Sponsor's own description

Hypertension (HTN) has become the largest driver of morbidity and mortality (M\&M) worldwide, affecting nearly 1 billion persons, the vast majority living in low- and middle-income countries (LMICs). While clinical research has identified highly-efficacious and inexpensive options to control HTN, rates of awareness, treatment and control of HTN are abysmally low. Implementation strategies that can effectively reach and engage patient populations while feasible within the constraints of frail health systems are urgently needed. In Peru, less than 10% of those with HTN are optimally controlled and thus avoidable M\&M continues to increase at unacceptable levels. In the proposed ANDES strategy, ANDES research team will study a vulnerable, impoverished indigenous Andean population that has a high prevalence of HTN (18.5%) and Type 2 Diabetes (T2D) (7.4%); living at high altitude. The study has two phases: UG3/UH3. During the formative UG3 phase (ended 12/31/22) we completed 3 aims, including: a) adapting community-based service delivery models for detection/control of HTN/T2D using stakeholder-engaged approaches; and b) assessed short-term implementation and service outcomes of pilot Health Fairs to detect HTN/T2D and a CHW-led model for engagement and treatment of HTN/T2D in two communities. A number of stakeholder in-depth interviews revealed significant limitations to HTN control. Discrete Choice Experiments (DCEs) surveys helped understand attributes for a community health worker (CHW)-led HTN care program that patients would value. Human-Centered Design was used to refine CHWs manual prototype, frequency and content of training sessions on patients, training CHW, supervision and integration into the healthcare system; facility-based health worker training content and approaches; identified opportunities for CHWs to improve health care system by helping to promote hypertension diagnosis, treatment and control. All these activities were used to refine the protocol that was tested in the pilot study where 1,079 subjects underwent blood pressure monitoring under a Standard Operating Procedure using electronic tablets to construct a REDCap database.

The UH3 phase will test the adapted ANDES strategy. ANDES is a two-arm, individually randomized superiority trial with parallel assignment. The overall objective of ANDES is to evaluate the effectiveness of a home-based Health Agent-led intervention in reducing blood pressure and improving diabetes control in patients from under-resourced communities in Puno, Peru. Potential ANDES study participants will be identified, screened, and recruited via 2 different mechanisms: 1) community health fairs and 2) healthcare facility-based enrollment. Health fair planning, will be conducted in collaboration with DIRESA \& EsSalud and local healthcare facility leaders. All health fair attendees will be screened for blood pressure measurements. ANDES research study staff will do screening at tents in the health facilities after doctors refer patients (or for any patients to visit who want) to inquire about their willingness for an in-person screening visit at their home. Recruitment will be rolling over 24 months during which 1068 participants in total (534 participants per arm) will be enrolled. To detect a difference in systolic blood pressure of 2.5 mmHg between intervention and control arms with 95% confidence, 90% power and a standard deviation of 12 mmHg, ANDES research team would need 485 participants per arm. Assuming a conservative lost-to-follow-up of 10% at 12 months, ANDES research team would need to randomize 1068 participants in total (534 participants per arm). The primary outcome is to determine if the ANDES intervention impacts SBP in comparison to the usual care arm 12 months after randomization. ANDES participants will initiate one of two care pathways according to the randomization assignment. Participants in the usual care group will be 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 ANDES intervention group will receive the ANDES implementation package consisting of health agent home visits for 12 consecutive months. Implementation package delivery will end after month 12, at which time intervention participants will be advised to obtain standard care from their local healthcare facility. Study outcome measures will be obtained in both the usual care and ANDES intervention group at months 12 and 18 post-randomization. All participants will receive visits at baseline, 12 and 18 months for study outcome assessments. Intervention participants will additionally receive a total of 12 visits by health agents as part of the intervention package, for a total of 18 visits for those assigned to the intervention group.

Publications & conference data

5 peer-reviewed publications reference this trial (live from Europe PMC):

1. Health system barriers to hypertension care in Peru: Rapid assessment to inform organizational-level change.
   Williams KN, Tenorio-Mucha J, Campos-Blanco K, Underhill LJ, et al · · 2024 · cited 6× · PMID 39159182 · DOI 10.1371/journal.pgph.0002404
2. Addressing Hypertension and Diabetes through Community-Engaged Systems (ANDES) in Puno, Peru: rationale and study protocol for a hybrid type 2 effectiveness and implementation randomized controlled trial.
   Underhill LJ, Williams KN, Cordova-Ascona L, Campos K, et al · · 2024 · cited 2× · PMID 39516847 · DOI 10.1186/s13063-024-08586-9
3. Medication adherence among people living with hypertension and diabetes in Puno, Peru: A secondary analysis of formative data of the ANDES trial.
   Acevedo PK, Lord KE, Williams KN, Underhill LJ, et al · · 2024 · cited 1× · PMID 39659891 · DOI 10.1177/26335565241292325
4. Co-developing a community health worker-led hypertension control intervention in Peru through a human-centered design approach.
   Williams KN, Campos-Blanco K, Underhill LJ, Tenorio-Much J, et al · · 2026 · PMID 42220976 · DOI 10.26633/rpsp.2026.50
5. ANDES trial and integration of the HEARTS model in Puno, Peru.
   Cuentas-Canal GM, Cordova-Ascona L, de Las Fuentes L, Soriano-Moreno AN, et al · · 2025 · PMID 41409883 · DOI 10.26633/rpsp.2025.120