Cardiovascular Disease Prevention in Europe and Sub-Saharan Africa
Condition: Cardiovascular Risk Factors
MeSH terms: Cardiovascular Diseases
Study type: Interventional

Summary: 
      Cardiovascular disease (CVD) is the leading cause of death in the world. 17.5 million people
      died in 2012 due to CVD (31% of all causes of death). In Europe more than 50% of deaths are
      due to CVD. The CVD mortality rate is higher in the lower socio-economic levels. Three
      quarters of CVD deaths occur in developing countries (LDCs). According to estimates in 2030,
      CVD will be responsible for more deaths than the sum of infectious, nutritional, maternal and
      perinatal diseases in developing countries. The lack of an adequate primary care network in
      developing countries limits the screening and treatment of people with CVRF. As a result,
      these people do not benefit from appropriate prevention, are diagnosed late and remain
      disabled or die at a young age, resulting in significant additional costs for families but
      also at the macroeconomic level.

      Cardiovascular risk factor prevention measures (CVRF) have been shown to be effective.
      Interventions are possible on a large scale (policies against smoking and unfavorable eating
      habits, promoting physical activity, etc.). Actions are possible at the individual level,
      both in primary prevention (fight against the FDRCV) and secondary, where many treatments
      have proven their effectiveness. These interventions are effective and profitable from a
      macroeconomic point of view. It has been estimated that the cost for such interventions would
      not exceed 4% of health expenditure in developing countries and 1-2% in rich countries.

      The World Health Organization (WHO) stresses the importance of the triad composed by the
      patient and his family, the community and health professionals. Results are possible only
      when these three components work together for the same purpose. Many studies show the benefit
      of people's involvement in care in rich and developing countries.

      SPICES project builds on progress in HIV / AIDS treatment in sub-Saharan Africa (SSA) and
      chronic disease management through the Innovative Care for Chronic Conditions (ICCC
      Framework), WHO plan. With regard to HIV treatment, these interventions have proven to be
      effective and cost-effective in many SSA countries, both in terms of disease control and
      adherence. These data on communicable and infectious diseases seem to be transferable to
      non-communicable diseases.

      These projects were born from the observation that the model of care of the rich countries
      (individual approach of the patient, centered on the hospital and the specialist with a
      regular clinical and paraclinical follow-up) could not be transposed to the developing
      countries, because the limitation of human, technical and financial resources. But also that
      this model was becoming more and more difficult to maintain in developed countries or
      resources become limited. New approaches need to be developed to increase the effectiveness
      of health systems.

      A paradigm shift is needed to improve the control of CVD with greater cost-effectiveness.

      The SPICES project incorporates the most up-to-date knowledge to improve the prevention and
      control of CVD in high-, middle- and low-income countries.

      Rich countries and developing countries are therefore involved in the study. The selected
      sites are France, United Kingdom, Belgium, South Africa and Uganda.

      Some main axes of the ICCC Framework will be developed in SPICES:

        -  improve the efficiency of health professionals through the delegation of skills and
           appropriate training,

        -  center care around the patient and his family and more generally his caregivers,

        -  simplify the monitoring and treatment protocols,

        -  support patients in their community and emphasize prevention, information and patient
           education.

      A first step of observation in the various countries made it possible to make an inventory of
      fixtures and to target the most adapted interventions.

      The following steps are the implementation of these interventions (delegation of skills,
      information campaign and screening, improve the availability of treatments, measure of
      strengthening of compliance, etc. ..) and their evaluation.

      This study, carried out in France and integrated into the SPICES project, will test the best
      non-pharmacological interventions selected in the community and by the community.
    


Intervention name(s): Multi-behavioral intervention
Intervention type(s): Other
Intervention description(s): The interventional group will then meet regularly under the aegis of the trainer to work on modifying each person's risk factors. The one-hour sessions will be scheduled every two weeks for two months and then every month for two months and then every three months until the end of the study (13 sessions). These sessions will be behavior change sessions, focused on goal setting, action planning, and problem solving. Trainers will facilitate these sessions and use motivational interviewing techniques
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention