A Community-Based Intervention for Managing Hypertension in Rural South Asia

Jafar, Tazeen H.; Gandhi, Mihir; Silva, H. Asita de; Jehan, Imtiaz; Naheed, Aliya; Finkelstein, Eric A.; Turner, Elizabeth L.; Morisky, Donald E.; Kasturiratne, Anuradhani; Khan, Aamir Hameed; Clemens, John D.; Ebrahim, Shah; Assam, Pryseley Nkouibert; Feng, Lixia

doi:10.1056/nejmoa1911965

Cited by 143 publications

(146 citation statements)

References 39 publications

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“…In Mexico, innovative technologies that combine community-based and household-based education with ongoing systematic professional education enabled earlier detection of CKD and improved outcomes 32 . Similarly, Thailand, Vietnam, Pakistan and Bangladesh are improving kidney health awareness and knowledge through multidisciplinary NCD care models built around community engagement, group counselling, capacity building and enhanced patient surveillance [33][34][35][36] .…”

Section: Education Gender and Inequalitymentioning

confidence: 99%

Sustainable Development Goals relevant to kidney health: an update on progress

et al. 2020

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Section: Education Gender and Inequalitymentioning

confidence: 99%

Sustainable Development Goals relevant to kidney health: an update on progress

et al. 2020

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“…Multiple studies from South Asia, and other low-resource settings, support the view that community health workers can provide clinically effective care for chronic diseases, such as hypertension and diabetes. 10-12 A role in diabetes prevention has not previously been evaluated. The results of the present study are thus anticipated to inform ongoing task-shifting in primary health care systems, in support of improved prevention and control for non-communicable disease.…”

Section: Discussionmentioning

confidence: 99%

“…11 A comprehensive multicomponent intervention in Bangladesh, Pakistan, and Sri Lanka, showed that trained CHWs working in partnership with public health care systems, improved blood pressure control among adults with hypertension. 12 Whether CHWs can deliver lifestyle modification for prevention of T2D in South Asians, that is effective, cost-effective and potentially scalable remains to be determined.…”

Section: Introductionmentioning

confidence: 99%

The iHealth-T2D study: rationale and design of a cluster randomised trial for prevention of Type 2 Diabetes amongst South Asians with central obesity and prediabetes

Kasturiratne

Ahmad

et al. 2020

Preprint

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BackgroundPeople from South Asia are at increased risk of type 2 diabetes (T2D). There is an urgent need to develop approaches for prevention of T2D in South Asians, that are cost-effective, generalisable and scalable across settings.HypothesisCompared to usual care, risk of T2D can be reduced amongst South Asians with central obesity or raised HbA1c, through a 12 month lifestyle modification programme delivered by community health workers.DesignCluster randomised clinical trial (1:1 allocation to Intervention or Usual care), carried out in India, Pakistan, Sri Lanka, and UK, with 30 sites per country (120 sites total). Target recruitment 3,600 (30 participants per site) with annual follow-up for three years.Entry criteriaSouth Asian, men or women, age 40-70 years with i. Central obesity (waist circumference ≥100cm in India and Pakistan; ≥90cm in Sri Lanka) and / or ii. Prediabetes (HbA1c 6.0-6.4% inclusive). Exclusion criteria: known type 1 or 2 diabetes, normal or underweight (body mass index<22kg/m2); pregnant or planning pregnancy; unstable residence or planning to leave the area; serious illness.EndpointsThe primary end point is new onset T2D at 3 years, defined as: i. HbA1c≥6.5% or ii. Physician diagnosis and on treatment for T2D. Secondary endpoints at 1 and 3 years are: i. Physical measures: waist circumference, weight and blood pressure; ii. Lifestyle measures: smoking status, alcohol intake, physical activity, dietary intake; iii. Biochemical measures: Fasting glucose, insulin and lipids (total and HDL cholesterol, triglycerides); and iv. Treatment compliance.InterventionLifestyle intervention (60 sites) or Usual care (60 sites). Lifestyle intervention was delivered by a trained community health worker over 12 months (5 one-one session, 4 group sessions, 13 telephone sessions) with the goal of the participants achieving e a 7% reduction in body mass index and a 10 cm reduction in waist circumference through i. improved diet and ii. increased physical activity. Usual care comprised a single 30 minute session of lifestyle modification advice from the community health worker.ResultsWe screened 33,212 people for inclusion into the study. We identified 10,930 people who met study entry criteria, amongst whom, 3,682 agreed to take part in the intervention. Study participants are 49.2% female and aged 52.8 (SD 8.2) years. Clinical characteristics are well balanced between Intervention and Usual care sites. More than 90% of follow-up visits are scheduled to be complete December 2020. Based on follow-up to end 2019, the observed incidence of T2D in the study population is in line with expectations (6.1% per annum).ConclusionThe iHealth-T2D study will advance understanding of strategies for prevention of diabetes amongst South Asians, use approaches for screening and intervention that are adapted for low-resource settings. Our study will thus inform the implementation of strategies for improving the health and well-being of this major global ethnic group.IRB approval16/WM/0171Trial registrationEudraCT 2016-001350-18. Registered 14 April 2016 https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/ihealth-t2d/ ; ClinicalTrials.gov NCT02949739. Registered 31 October 2016, https://clinicaltrials.gov/ct2/show/NCT02949739, First posted 31/10/2016.FunderEuropean Commission (award 643774) and National Institute for Health Research (award 16/136/68)

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“…We reviewed published and ongoing studies aimed at cardiovascular disease risk reduction from LMICs. A recent cluster randomized controlled trial (Feb,2020) performed in rural districts of Bangladesh, Pakistan and Sri Lanka depicted that by involving trained CHWs for counselling adults on CVD risk factors and monitoring BP, a significant reduction in mean SBP and all-cause mortality in intervention group is possible (30). A stepped wedge cluster randomized controlled trial conducted in India (2019) showed null difference in intervention and control arm with respect to CVD risk assessment by the CHWs at the level of village households with incorporation of clinical decision support system by PHC doctors for reduction in CVDs (31).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Community Health Worker based cardiovascular risk reduction strategies in urban slums of Bhopal: Rationale, design and baseline results of community based study

Pakhare

Joshi

Khadanga

et al. 2020

Preprint

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In urban India, about 35-40% of all adults have hypertension and about 10-15% have diabetes mellitus. National Program for Prevention and Control of Diabetes, Cancer and Stroke (NPCDCS) launched by Government of India has envisaged to screen all adults aged 30 years and above for presence of hypertension and diabetes mellitus in the community through population-based screening, initiate positively screened and diagnosed on drug therapy, and follow them up for treatment adherence. In this context, the current study aims to estimate burden of high cardiovascular disease (CVD) risk and to evaluate feasibility of community health workers-based strategies in reducing CVD among adults living in urban slums. We have identified and trained CHWs from within the urban slum communities in Bhopal, in chronic disease identification, skills in self-care and adherence promotion skills. At-risk individuals were linked to public health facilities as outlined under NPCDCS. Primary outcome is assessment of burden of high cardiovascular risk and its determinants. Secondary outcome is feasibility of community health worker-based adherence promotion. Between November 2017 and June 2018, CHWs in 14 urban slum clusters, screened a total of 6178 individuals out of which 4781 (77.43%) attended confirmation camp. Around 2393 (38.8%) were current tobacco users (smoking and/or smokeless), and 4697 (76.1%) has a sedentary lifestyle. Out of 758 (12.3%) known hypertensives, 354 (46.7%) had controlled hypertension whereas out of 333 (5.4%) known diabetes patients, 169 (57.5%) has controlled level of diabetes. In 813 (15%) out of 5416 and 151 (3.4%) out of 4486 adults, hypertension and diabetes was newly detected respectively. Results of this study have a potential to strengthen NPCDCS across all urban areas of the country. This manuscript describes detailed protocol of the study and presents baseline summary of CVD risk factor burden in urban slums of Bhopal.

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A Community-Based Intervention for Managing Hypertension in Rural South Asia

Cited by 143 publications

References 39 publications

Sustainable Development Goals relevant to kidney health: an update on progress

Sustainable Development Goals relevant to kidney health: an update on progress

The iHealth-T2D study: rationale and design of a cluster randomised trial for prevention of Type 2 Diabetes amongst South Asians with central obesity and prediabetes

Feasibility of Community Health Worker based cardiovascular risk reduction strategies in urban slums of Bhopal: Rationale, design and baseline results of community based study

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