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Bridging Income Generation with Group Integrated Care for cardiovascular risk reduction: Rationale and design of the
Rajesh Vedanthan1, Jemima H Kamano2, Hana Lee3
1Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Insights
Integrating group medical visits with microfinance can reduce cardiovascular disease (CVD) risk in individuals with diabetes in Kenya. This approach offers a cost-effective model for low-resource settings.
Area of Science:
- Global Health
- Cardiovascular Health
- Diabetes Management
Background:
- Cardiovascular disease (CVD) is the leading cause of global mortality, disproportionately affecting low and middle income countries (LMICs).
- Diabetes mellitus and pre-diabetes significantly increase CVD risk, making them a major concern for public health.
- Effective, affordable, and culturally relevant strategies are crucial for CVD risk reduction in these populations.
Purpose of the Study:
- To evaluate the effectiveness and cost-effectiveness of integrating group medical visits into microfinance groups for reducing CVD risk.
- To assess the impact of this integrated intervention on individuals with diabetes or at increased risk for diabetes in western Kenya.
- To explore contextual factors influencing the integration of healthcare interventions within microfinance settings.
Main Methods:
- A qualitative inquiry to understand contextual factors, followed by a four-arm cluster randomized trial.
- Intervention arms include usual care, usual care plus microfinance, group medical visits only, and integrated group medical visits and microfinance.
- Primary outcome: 1-year change in systolic blood pressure; secondary outcome: 1-year change in QRISK2 CVD risk score; cost-effectiveness analysis will be performed.
Main Results:
- This section is not available in the provided abstract.
Conclusions:
- The study aims to provide evidence on the effectiveness and cost-effectiveness of integrated interventions for CVD risk reduction.
- Findings are expected to offer generalizable methods and a potential model for adoption in resource-limited settings globally.
- This research addresses the critical need for scalable solutions to manage CVD risk in vulnerable populations.
Background:
Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with >80% of CVD deaths occurring in low and middle income countries (LMICs). Diabetes mellitus and pre-diabetes are risk factors for CVD, and CVD is the major cause of morbidity and mortality among individuals with DM. There is a critical period now during which reducing CVD risk among individuals with diabetes and pre-diabetes may have a major impact. Cost-effective, culturally appropriate, and context-specific approaches are required. Two promising strategies to improve health outcomes are group medical visits and microfinance.
Methods/Design:
This study tests whether group medical visits integrated into microfinance groups are effective and cost-effective in reducing CVD risk among individuals with diabetes or at increased risk for diabetes in western Kenya. An initial phase of qualitative inquiry will assess contextual factors, facilitators, and barriers that may impact integration of group medical visits and microfinance for CVD risk reduction. Subsequently, we will conduct a four-arm cluster randomized trial comparing: (1) usual clinical care, (2) usual clinical care plus microfinance groups only, (3) group medical visits only, and (4) group medical visits integrated into microfinance groups. The primary outcome measure will be 1-year change in systolic blood pressure, and a key secondary outcome measure is 1-year change in overall CVD risk as measured by the QRISK2 score. We will conduct mediation analysis to evaluate the influence of changes in social network characteristics on intervention outcomes, as well as moderation analysis to evaluate the influence of baseline social network characteristics on effectiveness of the interventions. Cost-effectiveness analysis will be conducted in terms of cost per unit change in systolic blood pressure, percent change in CVD risk score, and per disability-adjusted life year saved.
Discussion:
This study will provide evidence regarding effectiveness and cost-effectiveness of interventions to reduce CVD risk. We aim to produce generalizable methods and results that can provide a model for adoption in low-resource settings worldwide.
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