Impact of Bridging Income Generation with Group Integrated Care (BIGPIC) on Hypertension and Diabetes in Rural Western Kenya

Pastakia, Sonak D.; Manyara, Simon; Vedanthan, Rajesh; Kamano, Jemima H.; Menya, Diana; Andama, Benjamin; Chesoli, Cleophas; Laktabai, Jeremiah

doi:10.1007/s11606-016-3918-5

Cited by 60 publications

(102 citation statements)

References 23 publications

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“…three major comparisons (GMV vs UC; MF vs UC; GMV-MF vs UC)). Based on other CVD risk reduction trials in LMICs 74 and the preliminary results from our pilot data, 40 we expect a 5-mmHg reduction in SBP in the GMV or MF arms compared to the UC arm, and a 10-mmHg reduction in SBP in the GMV-MF arm compared to the UC arm. Our type I and type II error rates were conventionally set at 5% ( α = 0.05) and 20% ( β = 0.20), respectively, yielding a sample size powered at 80% (1- β = 0.80).…”

Section: Methodsmentioning

confidence: 62%

“…Microfinance group members mobilize and manage their own savings, provide interest-bearing loans to group members, offer a limited form of financial insurance, and contribute to a social fund that is used in cases of emergency or welfare issues of group members. 40 …”

Section: Methodsmentioning

confidence: 99%

“…However, AMPATH's Safety Net Program and CDM Program have been able to successfully ensure that 50% of each group's members will be study participants by encouraging the formation of an initial core with a minimum number of study participants and allowing initial core group members to invite others up to a maximum group size (30 members). 40 …”

Section: Methodsmentioning

confidence: 99%

“…Each GMV will be staffed by both the rural clinician and the local CHW (educator). The prototype of the GMV will be based on the model used for diabetes and hypertension in the USA, 69 as well as the pilot work that we have completed in Kenya, 40 and adapted and contextualized as described above using the participatory design process. Briefly, groups will consist of the same patients at each GMV.…”

Section: Methodsmentioning

confidence: 99%

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

Vedanthan

Kamano

Lee

et al. 2017

American Heart Journal

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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.

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Section: Methodsmentioning

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Vedanthan

Kamano

Lee

et al. 2017

American Heart Journal

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“…This highlights the twin importance of reducing logistical barriers and enhancing social support for patients. In Kenya, community-based group medical visits have led to sustained linkage and retention to hypertension care by delivering care to small patient groups at dates and places that are convenient to them [20]. This successful pilot work is now being followed up by a cluster randomised trial, in which social networks are being formally analysed [21].…”

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confidence: 99%

Find and Plug the Leak: Improving Adherence to Anti-Hypertensive Medicines

Njuguna

Vedanthan

2017

Cardiovasc Drugs Ther

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Elevated blood pressure is the leading preventable cause of cardiovascular disease (CVD) death and disability globally [1,2]. Adherence to anti-hypertensive medicines is the cornerstone to blood pressure control and subsequent reductions in CVD related death and disability [3]. However, adherence to anti-hypertensive medicines remains suboptimal globally and in sub-Saharan Africa (SSA). A recent systematic review estimated rates of non-adherence to be 45% globally, rising to 63% among African and Asian populations [4]. Furthermore, non-adherence was noted in 84% of patients with uncontrolled hypertension. Hypertension prevalence is highest in Africa (46%) compared to other regions and is expected to increase by more than 65% by 2025 [5,6]. Consequently, there is an urgent need to implement strategies to monitor and improve adherence to anti-hypertensive medicines in SSA.Chronic care delivery for hypertension and other noncommunicable diseases (NCDs) remains elusive to a majority of SSA countries where health systems have being designed primarily to address acute infective diseases, maternal and child health, and the HIV epidemic [7]. Where hypertension care is available, socio-economic barriers associated with receiving chronic care limit access and utilisation by patients, with a significant impact on decreasing adherence to medicines [8]. In recognition of this key barrier, some SSA countries have built universal healthcare delivery platforms that provide free or subsidised hypertension care and medicines to their population. However, even in these areas, adherence remains sub-optimal.In Namibia, where universal care for hypertension is provided through public health care (PHC) facilities, Nashilongo et al. assessed the levels and predictors of adherence to antihypertensive medication, and validated a modified version of the Hill-Bone scale for compliance [9]. Their study recruited 120 patients regularly receiving medication refills for hypertensive drugs in four semi-urban PHC facilities in Windhoek. The primary outcome measure was the proportion of patients with ≥80% adherence on the Hill-Bone compliance scale, predefined as acceptable adherence.The modified Hill-Bone Scale for compliance had reasonable internal consistency and construct validity for assessing adherence in this population. Mean adherence level was 77% which was lower than the pre-specified ≥80% level designating good adherence. 58% of patients had adherence levels ≤80%. Independent predictors of good adherence after multivariable logistical regression were having a treatment support buddy, never having missed a clinic appointment, and always attending follow-up visits. Although age and distance to the PHC facility were associated with good adherence on bivariate analysis, these associations were not sustained in the multivariable model. Finally, no association was found between sex, employment status, education level, presence of a comorbidity, and knowledge on hypertension medicines or complications with adherence.Several limitations of thi...

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Characteristics and Patterns of Retention in Hypertension Care in Primary Care Settings From the Hypertension Treatment in Nigeria Program

Orji

Baldridge

et al. 2022

JAMA Netw Open

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BACKGROUND More than 1.2 billion adults worldwide have hypertension. High retention in clinical care is essential for long-term management of hypertension, but 1-year retention rates are less than 50% in many resource-limited settings. OBJECTIVE To evaluate short-term retention rates and associated factors among patients with hypertension in primary health care centers in the Federal Capital Territory of Nigeria. DESIGN, SETTING, AND PARTICIPANTSIn this cohort study, data were collected by trained study staff from adults aged 18 years or older at 60 public, primary health care centers in Nigeria between January 2020 and July 2021 as part of the Hypertension Treatment in Nigeria (HTN) Program.Patients with hypertension were registered.EXPOSURES Follow-up visit for hypertension care within 37 days of the registration visit. MAIN OUTCOMES AND MEASURESThe main outcome was the 3-month rolling average 37-day retention rate in hypertension care, calculated by dividing the number of patients who had a follow-up visit within 37 days of their first (ie, registration) visit in the program by the total number of registered patients with hypertension during multiple consecutive 3-month periods. Interrupted time series analyses evaluated trends in retention rates before and after the intervention phase of the HTN Program. Mixed-effects, multivariable regression models evaluated associations between patient-, site-, and area council-level factors, hypertension treatment and control status, and 37-day retention rate. RESULTSIn total, 10 686 patients (68.3% female; mean [SD] age, 48.8 [12.7] years) were included in the analysis. During the study period, the 3-month rolling average 37-day retention rate was 41% (95% CI, 37%-46%), with wide variability among sites. The retention rate was higher among patients who were older (adjusted odds ratio [aOR], 1.01 per year; 95% CI, 1.01-1.02 per year), were female (aOR, 1.11; 95% CI, 1.01-1.23), had a higher body mass index (aOR, 1.01; 95% CI, 1.00-1.02), were in the Kuje vs the Abaji area council (aOR, 2.25; 95% CI, 1.25-4.04), received hypertension treatment at the registration visit (aOR, 1.27; 95% CI, 1.07-1.50), and were registered during the postintervention period (aOR, 1.16; 95% CI, 1.06-1.26). CONCLUSIONS AND RELEVANCEThe findings suggest that retention in hypertension care is suboptimal in primary health care centers in Nigeria, although large variability among sites was (continued) Key Points Question What are characteristics and patterns of retention in hypertension care in primary care settings in Nigeria? Findings In this cohort study of 10 686 patients with hypertension at 60 primary health care centers, the 3-month rolling average 37-day retention rate was 41%, with wide variability among centers. The retention rate was higher among patients who were older, were female, had a higher body mass index, lived in the Kuje area council, received hypertension treatment at the registration visit, and were registered during the postintervention period. Meaning The findings suggest t...

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Impact of Bridging Income Generation with Group Integrated Care (BIGPIC) on Hypertension and Diabetes in Rural Western Kenya

Abstract: The implementation of a contextualized care delivery model built around the unique needs of rural SSA participants led to statistically significant improvements in linkage to care and blood pressure reduction.

Cited by 60 publications

References 23 publications

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

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

Find and Plug the Leak: Improving Adherence to Anti-Hypertensive Medicines

Characteristics and Patterns of Retention in Hypertension Care in Primary Care Settings From the Hypertension Treatment in Nigeria Program

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