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 Generation through group Integrated Care (BIGPIC).DESIGN:The study prospectively tracked participation and health outcomes for participants in a screening eventand compared linkage frequencies to a historical comparison 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 include 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 over12 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 comprehensive microfinance-linked, community-based, group care model resulted in72.4 % of screen-positive participants returning for subsequent 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 around the unique needs of rural SSA participants led to statistically significant improvements in linkage to care and blood pressure reduction.