Community health worker-led, technology-enabled private sector intervention for diabetes and hypertension management among urban poor: a retrospective cohort study from large Indian metropolitan city

Abstract

ObjectivesWe assessed the effectiveness of community health workers (CHWs)-led, technology-enabled programme as a large-scale, real-world solution for screening and long-term management of diabetes and hypertension in low-income and middle-income countries.DesignRetrospective cohort design.SettingForty-seven low-income neighbourhoods of Hyderabad, a large Indian metropolis.ParticipantsParticipants (aged ≥20 years) who subscribed to an ongoing community-based chronic disease management programme employing CHWs and technology to manage diabetes and hypertension.Primary and secondary outcome measuresWe used deidentified programme data between 1 March 2015 and 8 October 2018 to measure participants’ pre-enrolment and post-enrolment retention rate and within time-interval mean difference in participants’ fasting blood glucose and blood pressure using Kaplan-Meier and mixed-effect regression models, respectively.Results51 126 participants were screened (median age 41 years; 65.2% women). Participant acquisition rate (screening to enrolment) was 4%. Median (IQR) retention period was 163.3 days (87.9–288.8), with 12 months postenrolment retention rate as 16.5% (95% CI 14.7 to 18.3). Reduction in blood glucose and blood pressure levels varied by participants’ retention in the programme. Adjusted mean difference from baseline ranged from −14.0 mg/dL (95% CI −18.1 to −10.0) to −27.9 mg/dL (95% CI −47.6 to −8.1) for fasting blood glucose; −2.7 mm Hg (95% CI −7.2 to 2.7) to −7.1 mm Hg (95% CI −9.1 to −4.9) for systolic blood pressure and −1.7 mm Hg (95% CI −4.6 to 1.1) to −4.2 mm Hg (95% CI −4.9 to −3.6) for diastolic blood pressure.ConclusionsCHW-led, technology-enabled private sector interventions can feasibly screen individuals for non-communicable diseases and effectively manage those who continue on the programme in the long run. However, changes in the model (eg, integration with the public health system to reduce out-of-pocket expenditure) may be needed to increase its adoption by individuals and thereby improve its cost-effectiveness.