Title: NIHR Global Health Research Group on collaborative care for cardiometabolic disease in Africa
Funder: Department of Health and Social Care

Abstract: Research question_x000D_ Can a model of care based on the chronic care model (CCM) and collaborative care model (CoCM) sustainably improve cardiometabolic health in low-to-middle income countries?_x000D_ _x000D_ Background_x000D_ Non-communicable diseases are rising in sub-Saharan Africa, mainly driven by cardiometabolic disease (CMD; cardiovascular disease, diabetes, hypertension). From a patient and healthcare systems perspective, it is more effective and efficient to have a cohesive approach to caring for CMDs given their shared aetiology and management. Based on unmet needs, local context, and evidence gaps, this Group will focus on CMD management in 3 ODA-eligible sub-Saharan African countries._x000D_ _x000D_ Aim_x000D_ Develop a CCM and CoCM model of care to improve care, outcomes and risk factor control for adults with CMD in Ghana, Kenya, and Mozambique in the COVID-19-era and beyond to contribute to the UN Sustainable Development Goals of promoting good health/well-being and reducing poverty/inequalities._x000D_ _x000D_ Objectives_x000D_ WP1: Identify and prioritise healthcare needs and available resources to support model development. _x000D_ WP2: Iteratively develop a model for people with CMD that is ready for implementation in SSA. _x000D_ WP3: Investigate the practical implications of delivering the model developed in WP2 and parameters required to design a randomised controlled trial. _x000D_ WP4: Maximise impact, uptake and implementation of the Group activities, by putting in place enablers to secure sustainability beyond the funding._x000D_ _x000D_ Methods_x000D_ WP1: Comprehensive literature review, scoping analysis (workshops) and needs assessment (quantitative analysis of existing data; qualitative analysis of focus groups) to create a Theory of Change. _x000D_ WP2: Engage with local communities to create and/or culturally adapt existing elements of the intervention, including a self-management programme, training packages for educators to deliver it, and a training programme to upskill healthcare professionals and community workers. _x000D_ WP3: A mixed-methods single-arm feasibility study (5 sites across the 3 countries; ~260 patient-participants plus healthcare professional and community leader participants). _x000D_ WP4: Develop an implementation plan, engage in knowledge mobilisation activities, co-develop a sustainability plan for the Group, and design an RCT. _x000D_ Theme 1: Implement a training and capacity building programme to develop future leaders in research management and expertise in SSA. _x000D_ Theme 2: Establish and expand a programme of community engagement and involvement (CEI) to deliver clear and effective involvement and engagement strategies, which will shape the delivery of this research programme, maximise impact and build lasting capacity to support CEI in future research._x000D_ _x000D_ Timelines _x000D_ WP1 (Prefunding-12); WP2 (M7-21); WP3 (M7-36); WP4, T1, T2 (M1-36)._x000D_ _x000D_ Impact and Dissemination_x000D_ The primary impact will be a substantial improvement in cardiometabolic health for those living in Ghana, Kenya and Mozambique. Academic and non-academic outputs will be disseminated through well-established methods, including press releases, social networks, open days, and relevant charities. Wider effects include improved research and community engagement and involvement capacity. These benefits will likely translate to substantial economic benefits for the local healthcare providers, patients, and health systems.

Lay abstract: The problem_x000D_ _x000D_ African healthcare was developed to focus on infectious diseases like HIV. This means that African healthcare is not set up well to cope with non-infectious diseases becoming more common._x000D_ _x000D_ The most common non-infectious diseases are ‘cardiometabolic diseases’. This includes heart disease, diabetes, and high blood pressure. All of these can lead to early death. It makes sense to tackle cardiometabolic diseases together because they can be treated in similar ways. For example, losing weight and increasing exercise can help with all of them._x000D_ _x000D_ Our aim_x000D_ _x000D_ Improve care and outcomes for heart disease, diabetes, and high blood pressure in three low income African countries: Ghana, Kenya, and Mozambique._x000D_ _x000D_ How we will do it_x000D_ _x000D_ We will complete four work packages (WPs) in all three countries._x000D_ _x000D_ WP1: Find out from patients, doctors and other key people what the most important healthcare needs are in this area. We will also find out what resources already exist so that we can make sure our work fits in well with that. We will do this by finding other relevant studies, holding workshops with relevant people (for example, patients, doctors, nurses and people from the government), looking at data that has been collected for other purposes, and collecting our own data from focus groups._x000D_ _x000D_ WP2: Create a model of care, which is a way of making sure that everybody is working together to improve health. The model will involve patients, doctors, nurses, pharmacists, and community leaders. Everybody will learn more about heart disease, diabetes, and high blood pressure. We will also try to improve other important parts of care, like technology. We will base it on programmes that we have tested before, and make sure that it is appropriate for the patients and healthcare system in each country._x000D_ _x000D_ WP3: Carry out a study to see if research around this model of care is appropriate and possible with 260 adults with cardiometabolic disease. This will give us information and experience to plan a future, larger study to test if it works._x000D_ _x000D_ WP4: Make sure that the work of this Group has a positive effect for patients, healthcare providers, and researchers, and that this carries on after the funding ends. We will do this by creating a plan to put our model into practice. We will then test this as part of WP3 and improve it based on that. We will also create a sustainability plan._x000D_ _x000D_ We will also have two development themes that will run alongside these WPs:_x000D_ _x000D_ Theme 1: Deliver a wide range of training options around research and other skills (including academic posts, peer-support and digital modules) for researchers within the African teams. This will support future research in the African countries._x000D_ _x000D_ Theme 2: Set up a programme to involve patients and the public in this and future research to make sure the needs and preferences of the public are at the forefront of decisions._x000D_ _x000D_ How we will involve patients_x000D_ _x000D_ People within the local communities, including those with heart disease, diabetes or high blood pressure, have worked with us on this application, including this summary. We will continue to build strong partnerships with these groups to support the programme. This will be central to our work through Theme 2._x000D_ _x000D_ What we will do with the results_x000D_ _x000D_ We will share our findings and make sure that the model is available and ready to use across Africa which will help the local people, healthcare and economies.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: CARDIOVASCULAR;METABOLIC AND ENDOCRINE