Community-based interventions for detection and management of diabetes and hypertension in underserved communities: a mixed-methods evaluation in Brazil, India, South Africa and the USA.

Luisa S Flor, Shelley Wilson, Paurvi Bhatt, Miranda Bryant, Aaron Burnett, Joseph N Camarda, Vasudha Chakravarthy, Chandrashekhar Chandrashekhar, Nayanjeet Chaudhury, Christiane Cimini, Danny V Colombara, Haricharan Conjeevaram Narayanan, Matheus Lopes Cortes, Krycia Cowling, Jessica Daly, Herbert Duber, Vinayakan Ellath Kavinkare, Patrick Endlich, Nancy Fullman, Rose Gabert, Thomas Glucksman, Katie Panhorst Harris, Maria Angela Loguercio Bouskela, Junia Maia, Charlie Mandile, Milena S Marcolino, Susan Marshall, Claire R McNellan, Danielle Souto de Medeiros, Sóstenes Mistro, Vasudha Mulakaluri, Jennifer Murphree, Marie Ng, J A Q Oliveira, Márcio Galvão Oliveira, Bryan Phillips, Vânia Pinto, Tara Polzer Ngwato, Tia Radant, Marissa B Reitsma, Antonio Luiz Ribeiro, Gregory Roth, Davi Rumel, Gaurav Sethi, Daniela Arruda Soares, Tsega Tamene, Blake Thomson, Harsha Tomar, Mark Thomaz Ugliara Barone, Sameer Valsangkar, Alexandra Wollum, Emmanuela Gakidou

Journal: BMJ global health 2021;5(6):e001959

PMID: 32503887

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Abstract

INTRODUCTION

As non-communicable disease (NCD) burden rises worldwide, community-based programmes are a promising strategy to bridge gaps in NCD care. The HealthRise programme sought to improve hypertension and diabetes management for underserved communities in nine sites across Brazil, India, South Africa and the USA between 2016 and 2018. This study presents findings from the programme's endline evaluation.

METHODS

The evaluation utilises a mixed-methods quasi-experimental design. Process indicators assess programme implementation; quantitative data examine patients' biometric measures and qualitative data characterise programme successes and challenges. Programme impact was assessed using the percentage of patients meeting blood pressure and A1c treatment targets and tracking changes in these measures over time.

RESULTS

Almost 60 000 screenings, most of them in India, resulted in 1464 new hypertension and 295 new diabetes cases across sites. In Brazil, patients exhibited statistically significant reductions in blood pressure and A1c. In Shimla, India, and in South Africa, country with the shortest implementation period, there were no differences between patients served by facilities in HealthRise areas relative to comparison areas. Among participating patients with diabetes in Hennepin and Ramsey counties and hypertension patients in Hennepin County, the percentage of HealthRise patients meeting treatment targets at endline was significantly higher relative to comparison group patients. Qualitative analysis identified linking different providers, services, communities and information systems as positive HealthRise attributes. Gaps in health system capacities and sociodemographic factors, including poverty, low levels of health education and limited access to nutritious food, are remaining challenges.

CONCLUSIONS

Findings from Brazil and the USA indicate that the HealthRise model has the potential to improve patient outcomes. Short implementation periods and strong emphasis on screening may have contributed to the lack of detectable differences in other sites. Community-based care cannot deliver its full potential if sociodemographic and health system barriers are not addressed in tandem.

Address: Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA.; Medtronic Foundation, Minneapolis, Minnesota, USA.; Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota, USA.; Regions Hospital, Saint Paul, Minnesota, USA.; Development Solutions, New Delhi, Delhi, India.; MAMTA Health Institute for Mother and Child, New Delhi, Delhi, India.; School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, Teofilo Otoni, MG, Brazil.; Public Health Seattle and King County, Seattle, Washington, USA.; ABT Associates Inc, Cambridge, Massachusetts, USA.; Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil.; Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA.; Department of Emergency Medicine, University of Washington, Seattle, Washington, USA.; School of Medicine, University of Washington, Seattle, Washington, USA.; Research and Teaching Institute, Hospital Sirio-Libanes, Sao Paulo, São Paulo, Brazil.; Telehealth Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.; HealthFinders Collaborative, Northfield, Minnesota, USA.; Regions Hospital, Saint Paul, Minnesota, USA.; National CASA/GAL Association for Children, Seattle, Washington, USA.; IBM Watson Health, San Jose, California, USA.; Health Policy and Management, University of California Los Angeles, Los Angeles, California, USA.; Social Surveys Africa, Johannesburg, Gauteng, South Africa.; Research and Teaching Institute, Hospital Sirio-Libanes, Sao Paulo, São Paulo, Brazil.; School of Medicine, Municipal University Sao Caetano do Sul, Sao Caetano do Sul, Sao Paulo, Brazil.; Pillsbury United Communities, Minneapolis, Minnesota, USA.; Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK.; Medtronic Foundation, Minneapolis, Minnesota, USA.; Global Health Leaders, Public Health Institute, Sao Paulo, Sao Paulo, Brazil.; Research and Monitoring Systems, The Catholic Health Association of India, Hyderabad, Telangana, India.; Ibis Reproductive Health, Cambridge, Massachusetts, USA.; Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA [email protected].

DOI: 10.1136/bmjgh-2019-001959

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https://medlineplus.gov/diabetes.html

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https://antibodies.cancer.gov/detail/CPTC-HLA-B-1

MeSH Terms: Brazil, Diabetes Mellitus, Humans, Hypertension, India, South Africa