Community Health Workers Improve Linkage to Hypertension Care in Western Kenya

Vedanthan, Rajesh; Kamano, Jemima; DeLong, Allison; Naanyu, Violet; Binanay, Cynthia; Bloomfield, Gerald S.; Chrysanthopoulou, Stavroula A.; Finkelstein, Eric A.; Hogan, Joseph W.; Horowitz, Carol R.; Inui, Thomas S.; Menya, Diana; Orango, Vitalis; Velázquez, Eric J.; Were, Martin Chieng; Fuster, Valentín

doi:10.1016/j.jacc.2019.08.003

Cited by 68 publications

(81 citation statements)

References 36 publications

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“…In our setting, all of the above dynamics appeared to be relevant. We have previously described substantial levels of material deprivation and lack of health insurance in western Kenya (31), thus lending support to care delivery models, such as BIGPIC, that incorporate social determinants of health into clinical care (11).…”

Section: Discussionmentioning

confidence: 86%

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

Dong

Leung

Naert

et al. 2020

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Background: Non-communicable diseases (NCDs) are the leading cause of mortality in the world, and innovative approaches to NCD care delivery are being actively developed and evaluated. Combining the group-based experience of microfinance and group medical visits is a novel approach to NCD care delivery that has demonstrated beneficial impact in previous pilot studies. However, the contextual factors, facilitators, and barriers impacting wide-scale implementation of these approaches within a low- and middle-income country setting are not well known.Methods: Two types of qualitative group discussion were conducted: 1) mabaraza (singular, baraza), a traditional East African community gathering used to discuss and exchange information in large group settings; and 2) focus group discussions (FGDs) among rural clinicians, community health workers, microfinance group members, and patients with NCDs. Trained research staff members led the discussions using structured question guides. Content analysis was performed with NVivo using deductive and inductive codes that were then grouped into themes.Results: We conducted 5 mabaraza and 16 FGDs. A total of 205 individuals (113 men and 92 women) participated in the mabaraza, while 162 individuals (57 men and 105 women) participated in the FGDs. Participants expressed interest in participating in microfinance and group medical visits, but cited several key challenges: 1) stigma of chronic disease, 2) earned skepticism of the health system, and 3) socio-economic fragility.Conclusions: Our qualitative study revealed and illuminated actionable factors that could impact the success of implementation of group medical visits and microfinance initiatives for NCD care. While several challenges were highlighted, participants also felt that planned interventions could address and mitigate the impact of these dynamic factors. We anticipate that our approach and analysis provides new insights and methodological techniques that will be relevant to other low-resource settings worldwide.Trial Registration: Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015

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Section: Discussionmentioning

confidence: 86%

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

Dong

Leung

Naert

et al. 2020

Preprint

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“…Patients with hypertension and diabetes received group medical visits comprising microfinance, group health education, personalized clinical consultation, laboratory tests, and medications from clinicians who travel to the group meetings. The combined interventions: first, increased their rate of linkage to care from 31 to 72 percentage; second, increased retention in care from 31 to 70 percentage; and had greater reductions in SBP (21.0 vs. 9.7 mmHg) [ 3 , 4 ]. Similarly substantial improvements in adherence, retention, and viral suppression have been realized in settings that incorporate group-based microfinance activities into HIV care delivery [ 5 ].…”

Section: Group Medical Care Prior To Coronavirus Disease 2019 Restricmentioning

confidence: 99%

Preserving 2 decades of healthcare gains for Africa in the coronavirus disease 2019 era

Pastakia

Braitstein

Galárraga

et al. 2020

Aids

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As coronavirus disease 2019 (Covid-19) restrictions upend the community bonds that have enabled African communities to thrive in the face of numerous challenges, it is vital that the gains made in community-based healthcare are preserved by adapting our approaches. Instead of reversing the many gains made through locally driven development partnerships with international funding agencies for other viral diseases like HIV, we must use this opportunity to adapt the many lessons learned to address the burden of Covid-19. Programs like the Academic Model Providing Access to Healthcare are currently leveraging widely available technologies in Africa to prevent patients from experiencing significant interruptions in care as the healthcare system adjusts to the challenges presented by Covid-19. These approaches are designed to preserve social contact while incorporating physical distancing. The gains and successes made through approaches like group-based medical care must not only continue but can help expand upon the extraordinary success of programs like President's Emergency Plan for AIDS Relief.

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“…The baseline questionnaire of the LARK study collected data about employment status, eld of employment, and reason for unemployment when relevant (8). Monthly income was asked in 5,000 to 10,000 Kenyan shilling (KS) increments (roughly equivalent to $50 -$100 increments).…”

Section: Surveymentioning

confidence: 99%

“…The LARK Hypertension study is a cluster randomized controlled trial that demonstrated that community health workers, equipped with behavioral communication strategies and smartphone decision-support tools, can increase linkage to hypertension care and yield modestly improved but not statistically signi cant blood pressure reduction among individuals with hypertension in rural Western Kenya. (8) We present here an analysis of baseline data from the trial, focusing on sex differences in self-reported patterns of health care utilization and costs in this population.…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Healthcare Utilization and Costs among Individuals with Elevated Blood Pressure: The LARK Study from Western Kenya

Sikka

DeLong

Kamano

et al. 2020

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Background: Elevated blood pressure is the leading risk factor for global mortality. While it is known that there exist differences between men and women with respect to socioeconomic status, self-reported health, and healthcare utilization, there are few published studies from Africa. This study therefore aims to characterize differences in healthcare utilization and costs between men and women with elevated blood pressure in Kenya.Methods: Data from 1447 participants enrolled in the LARK Hypertension study in western Kenya were analyzed. Latent class analysis based on nine dependent variables was performed to describe patterns of healthcare utilization and costs in the study population. Regression analysis was then performed to describe the relationship between different demographics and each outcome. Results: Women in our study had higher rates of unemployment (28% vs 12%), were more likely to report lower monthly earnings (72% vs 51%), and had more outpatient visits (39% vs 28%) and pharmacy prescriptions (42% vs 30%). Three patterns of healthcare utilization were described: (1) individuals with low healthcare utilization, (2) individuals who utilized care but paid low out-of-pocket costs, and (3) individuals who utilized care but had higher out-of-pocket costs. Women and those with health insurance were more likely to be in the high-cost utilizer group. Women were also more likely to report lower quality-of-life and functional health status, including pain, mobility, self-care, and ability to perform usual activities. Conclusions: Men and women with elevated blood pressure in Kenya have different health care utilization behaviors, cost and economic burdens, and health outcomes. Awareness of these sex differences can help inform targeted interventions in these populations. Trial registration: ClinicalTrials.gov Identifier: NCT01844596, Date of registration: May 1, 2013. https://clinicaltrials.gov/ct2/show/NCT01844596

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Community Health Workers Improve Linkage to Hypertension Care in Western Kenya

Cited by 68 publications

References 36 publications

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

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

Preserving 2 decades of healthcare gains for Africa in the coronavirus disease 2019 era

Sex Differences in Healthcare Utilization and Costs among Individuals with Elevated Blood Pressure: The LARK Study from Western Kenya

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