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
