Bridging Income Generation with Group Integrated Care for cardiovascular risk reduction: Rationale and design of the BIGPIC study

Abstract

Background Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with >80% of CVD deaths occurring in low and middle income countries (LMICs). Diabetes mellitus and pre-diabetes are risk factors for CVD, and CVD is the major cause of morbidity and mortality among individuals with DM. There is a critical period now during which reducing CVD risk among individuals with diabetes and pre-diabetes may have a major impact. Cost-effective, culturally appropriate, and context-specific approaches are required. Two promising strategies to improve health outcomes are group medical visits and microfinance. Methods/Design This study tests whether group medical visits integrated into microfinance groups are effective and cost-effective in reducing CVD risk among individuals with diabetes or at increased risk for diabetes in western Kenya. An initial phase of qualitative inquiry will assess contextual factors, facilitators, and barriers that may impact integration of group medical visits and microfinance for CVD risk reduction. Subsequently, we will conduct a four-arm cluster randomized trial comparing: 1) usual clinical care, 2) usual clinical care plus microfinance groups only, 3) group medical visits only, and 4) group medical visits integrated into microfinance groups. The primary outcome measure will be one-year change in systolic blood pressure, and a key secondary outcome measure is one-year change in overall CVD risk as measured by the QRISK2 score. We will conduct mediation analysis to evaluate the influence of changes in social network characteristics on intervention outcomes, as well as moderation analysis to evaluate the influence of baseline social network characteristics on effectiveness of the interventions. Cost-effectiveness analysis will be conducted in terms of cost per unit change in systolic blood pressure, percent change in CVD risk score, and per disability-adjusted life year saved. Discussion This study will provide evidence regarding effectiveness and cost-effectiveness of interventions to reduce CVD risk. We aim to produce generalizable methods and results that can provide a model for adoption in low-resource settings worldwide.

Disparities in Management of Cardiovascular Disease in Rural South Africa

“…This suggests that mortality may be decreased through improvement in treatment of these risk factors coupled with greater community education on the importance of lifestyle modification. Initiatives to achieve these goals, like population-wide screening for hypertension and diabetes, engagement of community resources and governance structures, geographic decentralization of care services, and group medical visits alone or integrated into microfinance groups, have been previously proposed in SSA 56 and some of these interventions are currently under investigation 57 .…”

The relationship between a microfinance-based healthcare delivery platform, health insurance coverage, health screenings, and disease management in rural Western Kenya

“…BIGPIC Family offers a combination of interventions designed to synergistically improve health and well-being, including: group-based microfinance services, education about NHIF, point-of-care screening and management for hypertension and diabetes, group-based primary care delivery during microfinance meetings, business literacy, and agricultural training ( Fig. 1) [29][30][31]. The microfinance groups are the platform through which much of the BIGPIC programming and healthcare is delivered.…”

Chronic Disease Stigma, Skepticism of the Health System, and Socio-economic Fragility: Qualitative Assessment of Factors Impacting Receptiveness to Group Medical Visits and Microfinance for Non-Communicable Disease Care in Rural Kenya

“…The Bridging Income Generation with GrouP Integrated Care (BIGPIC) study in western Kenya is evaluating the impact of MF and GMVs on cardiovascular risk reduction among individuals with and at increased risk of diabetes. (12) The formative phase of this study aimed to identify the contextual factors, facilitators, and barriers that may impact the success this approach. In this paper, we report the results of that pre-implementation formative inquiry.…”