Community-based interventions for detection and management of diabetes and hypertension in underserved communities: a mixed-methods evaluation in Brazil, India, South Africa and the USA
Authors: Flor Luisa S , Wilson Shelley , Bhatt Paurvi , Bryant Miranda , Burnett Aaron , Camarda Joseph N , Chakravarthy Vasudha , Chandrashekhar Chandrashekhar , Chaudhury Nayanjeet , Cimini Christiane , Colombara Danny V , Narayanan Haricharan Conjeevaram , Cortes Matheus Lopes , Cowling Krycia , Daly Jessica , Duber Herbert , Ellath Kavinkare Vinayakan , Endlich Patrick , Fullman Nancy , Gabert Rose , Glucksman Thomas , Harris Katie Panhorst , Loguercio Bouskela Maria Angela , Maia Junia , Mandile Charlie , Marcolino Milena S , Marshall Susan , McNellan Claire R , Medeiros Danielle Souto de , Mistro Sóstenes , Mulakaluri Vasudha , Murphree Jennifer , Ng Marie , Oliveira J A Q , Oliveira Márcio Galvão , Phillips Bryan , Pinto Vânia , Polzer Ngwato Tara , Radant Tia , Reitsma Marissa B , Ribeiro Antonio Luiz , Roth Gregory , Rumel Davi , Sethi Gaurav , Soares Daniela Arruda , Tamene Tsega , Thomson Blake , Tomar Harsha , Ugliara Barone Mark Thomaz , Valsangkar Sameer , Wollum Alexandra , Gakidou Emmanuela 
Published: June 2020

IntroductionAs non-communicable disease (NCD) burden rises worldwide, community-based programmes are a promising strategy to bridge gaps in NCD care. The HealthRise programme sought to improve hypertension and diabetes management for underserved communities in nine sites across Brazil, India, South Africa and the USA between 2016 and 2018. This study presents findings from the programme’s endline evaluation.MethodsThe evaluation utilises a mixed-methods quasi-experimental design. Process indicators assess programme implementation; quantitative data examine patients’ biometric measures and qualitative data characterise programme successes and challenges. Programme impact was assessed using the percentage of patients meeting blood pressure and A1c treatment targets and tracking changes in these measures over time.ResultsAlmost 60 000 screenings, most of them in India, resulted in 1464 new hypertension and 295 new diabetes cases across sites. In Brazil, patients exhibited statistically significant reductions in blood pressure and A1c. In Shimla, India, and in South Africa, country with the shortest implementation period, there were no differences between patients served by facilities in HealthRise areas relative to comparison areas. Among participating patients with diabetes in Hennepin and Ramsey counties and hypertension patients in Hennepin County, the percentage of HealthRise patients meeting treatment targets at endline was significantly higher relative to comparison group patients. Qualitative analysis identified linking different providers, services, communities and information systems as positive HealthRise attributes. Gaps in health system capacities and sociodemographic factors, including poverty, low levels of health education and limited access to nutritious food, are remaining challenges.ConclusionsFindings from Brazil and the USA indicate that the HealthRise model has the potential to improve patient outcomes. Short implementation periods and strong emphasis on screening may have contributed to the lack of detectable differences in other sites. Community-based care cannot deliver its full potential if sociodemographic and health system barriers are not addressed in tandem.