Reference Number: PhD Project 01/2026
Director of Studies: Benjamin Tsofa
Names of co-supervisors: Nancy Kagwanja and Anthony Etyang
Country: Kenya
BRIEF DESCRIPTION OF THE PROJECT
Background and Introduction
Sub-Saharan Africa (SSA) bears a disproportionate burden of premature cardiovascular disease (CVD), with very low levels of detection, treatment, and control of major CVD risk factors. The crisis is complicated by the fact that heart CVD has many causes (risk factors), including high blood pressure and high cholesterol. However, treating risk factors is challenging. Fewer than 1 in 20 people in SSA with high blood pressure have it controlled. Even fewer receive treatment for high cholesterol.
In our previous work in the Improving Hypertension Control in Rural Sub-Saharan Africa (IHCoR-Africa) project, our team identified several factors contributing to this treatment gap. Individuals struggle to access care and have low awareness of risk factors. Healthcare workers lack sufficient training or resources. Finally, there is a poor availability of medications.
Potential solutions include patient support groups; task-sharing among doctors, nurses, and community health workers; and the use of a combination of medications to address multiple CVD risk factors. However, these solutions come from studies focused on only one risk factor. Previous research has been conducted in clinical settings, while evidence from other diseases highlights the need for care closer to the community. Finally, findings have not been successfully moved from research to the wider population.
Cardiovascular disease risk reduction in sub–Saharan Africa (CARisSA) is a five-year NIHR RIGHT-funded programme that aims to co-design, test feasibility, and evaluate the effectiveness of a community-centred, multi-component intervention to reduce overall CVD risk in Kenya and The Gambia. The overall goal of CARisSA is to design and test a community-centred intervention to reduce the overall risk of heart disease in sSA.
Complex health interventions, particularly those delivered across multiple levels of the health system and involving community health workers, peer support, digital tools, and pharmacological management, require robust process evaluation to support interpretation of trial outcomes and inform scale-up. Effective data alone are insufficient to explain variation in outcomes, implementation challenges, adaptations, or sustainability. This is especially critical in low-resource settings where health system constraints and contextual factors strongly influence intervention delivery and impact.
Alongside a large cluster randomised controlled trial and economic evaluation, CARisSA includes a dedicated process evaluation (Work Package 4) to understand how, why, and under what conditions the intervention works.
Purpose and aim of the studentship
The primary aim of this PhD studentship is to conduct an in-depth, theory-informed process evaluation of the CARisSA intervention. The studentship will examine implementation processes, mechanisms of impact, and contextual influences at individual, organizational, community, and system levels in Kenya and The Gambia.
The work will generate evidence to explain trial findings, identify factors influencing fidelity, reach, adoption, and sustainability, and provide actionable lessons for policymakers and health system actors considering scale-up of community-centred cardiovascular risk interventions in sub-Saharan Africa.
This studentship will be conducted within the broader CARisSA research programme and will contribute directly to Work Package 4.
OVERALL RESEARCH QUESTIONS
The overall research question for this studentship will be:
How, why, and under what conditions does the CARisSA community-centred intervention influence cardiovascular risk management outcomes in Kenya and The Gambia?
Specifically, the studentship will address the following sub-questions:
- How is the intervention implemented across different sites and health system levels, in terms of reach, fidelity, adoption, and adaptation?
- What mechanisms influence behaviour and practice among patients, community health workers, and healthcare providers?
- What contextual factors at individual, organisational, community, and system levels shape implementation and outcomes?
- What are stakeholder perceptions of feasibility, acceptability, sustainability, and potential for scale-up?
Specific objectives for the studentship
- Assess implementation processes, including reach, fidelity, adoption, and maintenance of the CARisSA intervention.
- Explore mechanisms of impact influencing patient, provider, and community behaviours and practices.
- Examine contextual influences shaping implementation across health system levels.
- Assess perceived sustainability and scalability of the intervention within existing health system structures.
SCOPE OF SUPPORT
This is a three-year PhD studentship to be based at KWTRP. The selected candidate will be supported in applying for and registering for a PhD at the Open University - UK. The candidate will be supervised by Benjamin Tsofa, Nancy Kagwanja, and Anthony Etyang, research scientists at KWTRP. The selected candidate will receive a stipend, medical insurance, and financial support to cover tuition, academic-related fees, travel expenses, and research expenses.
METHOD OF APPLICATION
Interested applicants are required to submit the following.
- One-page application letter.
- An updated curriculum vitae with a contact email address and telephone number.
- A copy of the highest degree and a certified copy of an academic transcript.
- One-page personal statement stating the preferred area of research, reasons for selecting the area, and future career ambitions.
- A letter of support from an academic referee stating the potential of the candidate to succeed in a research career.
SELECTION PROCESS
Shortlisted candidates will be invited to an interview, either in person or via videoconference. The successful candidate in the interview will be offered PhD training support.
NOTE: ONLY ONLINE APPLICATIONS will be accepted.
STARTING DATE: May 2026.
APPLICATION DEADLINE: March 13, 2026
NOTE: Only shortlisted candidates will be contacted