Pastakia, S.D., Manyara, S.M., Vedanthan, R., Kamano, J.H., Menya, D., et al., Impact of Bridging Income Generation with Group Integrated Care (BIGPIC) on Hypertension and Diabetes in Rural Western Kenya. J Gen Intern Med, 2016.

Abstract

BACKGROUND: Rural settings in Sub-Saharan Africa (SSA) consistently report low participation in non- communicable disease (NCD) treatment programs and poor outcomes. OBJECTIVE: The objective of this study is to assess the impact of the implementation of a patient-centered rural NCD care delivery model called Bridging Income Genera- tion through grouP Integrated Care (BIGPIC). DESIGN: The study prospectively tracked participation and health outcomes for participants in a screening event and compared linkage frequencies to a historical compar- ison group. PARTICIPANTS: Rural Kenyan participants attending a voluntary NCD screening event were included within the BIGPIC model of care. INTERVENTIONS: The BIGPIC model utilizes a contextu- alized care delivery model designed to address the unique barriers faced in rural settings. This model emphasizes the following steps: (1) find patients in the community, (2) link to peer/microfinance groups, (3) integrate education, (4) treat in the community, (5) enhance economic sustain- ability and (6) generate demand for care through incentives. MAIN MEASURES: The primary outcome is the linkage frequency, which measures the percentage of patients who return for care after screening positive for either hypertension and/or diabetes. Secondary measures in- clude retention frequencies defined as the percentage of patients remaining engaged in care throughout the 9- month follow-up period and changes in systolic (SBP) and diastolic blood pressure (DBP) and blood sugar over 12 months. KEY RESULTS: Of the 879 individuals who were screened, 14.2 % were confirmed to have hypertension, while only 1.4 % were confirmed to have diabetes. The implementation of a compr ehensive microfinance- linked, community-based, group care model resulted in 72.4 % of screen-positive participants returning forsubsequent care, of which 70.3 % remained in care through the 12 months of the evaluation period. Patients remaining in care demonstrated a statistically significant mean decline of 21 mmHg in SBP [95 % CI (13.9 to 28.4), P < 0.01] and 5 mmHg drop in DBP [95 % CI (1.4 to 7.6), P < 0.01]. CONCLUSIONS: The implementation of a contextualized care delivery model built aroundthe unique needs of rural SSA participants led to statistically significant improve- ments in linkage to care and blood pressure reduction