Rationale: Poor access to care and physician shortage are major barriers to hypertension control in sub-Saharan Africa. Implementation of evidence-based systems-level strategies targeted at these barriers are lacking. Objective: To evaluate the comparative effectiveness of provision of health insurance coverage (HIC) alone versus a nurse-led task-shifting strategy for hypertension control (TASSH) plus HIC on systolic BP reduction among patients with uncontrolled hypertension in Ghana. Methods and Findings: Using a pragmatic cluster-randomized trial, 32 community health...