Addressing Gaps in the Hypertension and Diabetes Care Continuum in Rural Bangladesh Through mHealth and Decentralized Primary Care: The Dinajpur Study

Status: Recruiting
Location: See location...
Intervention Type: Combination product
Study Type: Interventional
Study Phase: Phase 1
SUMMARY

In the present implementation study, we aim to document the experience of implementing integrated, decentralized primary care in rural Bangladesh, including components of healthcare provider training, mHealth, decentralization with task shifting, and community-based care, and to generate data on the effectiveness and cost-effectiveness of the multicomponent integrated care as compared to usual care and to mHealth intervention alone. We will also Investigate the factors that explain how the interventions influence hypertension and diabetes management and explore barriers/facilitators to delivering and sustaining intervention. We will conduct mixed-methods research to understand how the intervention influences treatment and prevention in this patient population. Particularly, we will assess lifestyle changes (i.e., smoking, dietary salt intake, physical activity, alcohol consumption), and burden for patients (e.g., waiting time, travel-related cost) at individual and community level. Qualitative data will shed light on facilitators and barriers to hypertension and diabetes prevention and control from the perspectives of patients (and their families), primary care providers, public health officials, and other stakeholders. Additionally, we will undertake a health economic evaluation of the interventions for primary care systems. A comprehensive evaluation of cost and effectiveness will be important for the models tested, providing necessary evidence for policymakers and stakeholders to scale up the interventions. We hypothesize that compared with usual care, the multicomponent decentralized primary care will improve all steps along hypertension and diabetes care continuum. On the other hand, we hypothesize that the mHealth intervention alone (Simple App) may improve BP and glycemic control compared with usual care but will have a limited impact on rates of screening, diagnosis, and treatment. We also hypothesize that the multicomponent integrated care will lead to a higher treatment success rate relative to mHealth intervention alone.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 40
Healthy Volunteers: t
View:

• All participants aged 40 or above

• With hypertension and diabetes

• Residents of specific study areas

• Willing to participate

Locations
Other Locations
Bangladesh
BRAC James P Grant School of Public Health
RECRUITING
Dhaka
Contact Information
Primary
Malay K Mridha, PhD
malay.mridha@bracu.ac.bd
+8801715190573
Backup
Wubin Xie, DrPH
wubin.xie@ntu.edu.sg
Time Frame
Start Date: 2024-01-01
Estimated Completion Date: 2026-09-30
Participants
Target number of participants: 6750
Treatments
Experimental: Multicomponent decentralized care
mHealth plus decentralized primary care The multi-component intervention aims to increase access to primary care, and to improve care quality and patient retention. The intervention package includes mHealth, decentralization with task sharing, community-based care, and supportive monitoring visits
Active_comparator: mHealth
In subdistrict with mHealth intervention only, we will provide the same training on hypertension and diabetes care to physicians and nurses at NCD corner in UHC, and training to use Simple App for hypertension and diabetes management. Quarterly supervision by higher-level health administrators and medical professionals to NCD corner helps solve issues with patient management, medication supply, etc. Visits may be informed by a performance summary made available by the Simple App dashboard. Two supportive visits by the study team will be organized to help NCD Corner solve technical issues with Simple App. The healthcare providers at NCD Corner will decide how they react to the information made available by the digital tool, and similarly, the patient component will not be included. Patient pathways remain the same as usual care.
No_intervention: Usual care
Existing usual care provided by government primary care system including screening, treatment initiating, drug refill, and routine follow-up, at subdistrict NCD corner. Community clinics and CHWs have less involvement in NCD care provision.
Related Therapeutic Areas
Sponsors
Collaborators: Nanyang Technological University, Imperial College London
Leads: BRAC University

This content was sourced from clinicaltrials.gov