Primary research aim
Aim 1: Identify the contextual factors, facilitators, and barriers that may impact integration of group medical visits and microfinance for CVD risk reduction, using a combination of qualitative research methods: 1) baraza (traditional community gathering) form of inquiry; and 2) focus group discussions among individuals with diabetes or at increased risk for diabetes, microfinance group members, and rural health workers.
Subsidiary aim 1.1: Use identified facilitators and barriers to develop a contextually and culturally appropriate integrated group medical visit-microfinance model to reduce CVD risk among individuals with diabetes or at increased risk of diabetes. We will assess this model’s acceptability and feasibility by conducting focus group discussions with patients, microfinance group members, and health workers.
Secondary research aim
Aim 2: Evaluate the effectiveness of group medical visits and microfinance groups for CVD risk reduction among individuals with diabetes or at increased risk for diabetes, by conducting a four-arm cluster randomized trial comparing: 1) usual clinical care; 2) usual clinical care plus microfinance groups only; 3) group medical visits only (no microfinance); and 4) group medical visits integrated into microfinance groups. The primary outcome measure will be one-year change in systolic blood pressure (SBP), and a key secondary outcome will be change in QRISK2 CVD risk score, which has been validated for Black Africans.
Subsidiary Aim 2.1: Conduct mediation analysis to evaluate the influence of changes in social network characteristics on intermediate factors and intervention outcomes and moderation analysis to evaluate the influence of baseline social network characteristics on effectiveness of interventions.
Aim 3: Evaluate the incremental cost-effectiveness of each intervention arm of the trial, in terms of costs per unit decrease in SBP, per percent change in CVD risk score, and per disability-adjusted life year saved.
This research project will add to the existing knowledge base on innovative, scalable, and sustainable strategies for reducing CVD risk in diabetes and other chronic diseases in LMICs and other low-resource settings. If proven to be effective, we are poised to expand the approach beyond the trial, thus ensuring that this research will have a significant and positive health impact on a larger population.
Research objectives and methodology
The objective of our project is to utilize a transdisciplinary implementation research approach to address the challenge of reducing CVD risk in low-resource settings. The central hypothesis is: group medical visits integrated into microfinance groups will be effective and cost-effective in reducing CVD risk among individuals with diabetes and at increased risk for diabetes in western Kenya, and that the key modifiable CVD risk factor to be addressed is BP. We hypothesize that group medical visits and microfinance may each reduce CVD risk, but the integration of group medical visits and microfinance will yield the largest gains. We further hypothesize that changes in social network characteristics may mediate the impact of interventions on the primary outcome, and that baseline social network characteristics may moderate the impact of interventions.
- Eldoret, Kenya
- Eric Finkelstein, Duke University, Durham, USA
- Joseph Hogan, Brown University, Providence, USA
- Jemima Kamano, Moi University, Eldoret, Kenya
- Sonak Pastakia, Purdue University, West Lafayette, USA
- Rajesh Vedanthan, Icahn School of Medicine at Mount Sinai, New York, USA
- Benjamin Andama, Moi University, Eldoret, Kenya
- Gerald Bloomfield, Duke University, Durham, USA
- Allison DeLong, Brown University, Providence, USA
- David Edelman, Duke University, Durham, USA
- Valentin Fuster, Icahn School of Medicine at Mount Sinai, New York, USA
- Carol Horowitz, Icahn School of Medicine at Mount Sinai, New York, USA
- Peninah Kiptoo, Moi University, Eldoret, Kenya
- Claire Kofler, Icahn School of Medicine at Mount Sinai, New York, USA
- Hana Lee, Brown University, Providence, USA
- Diana Menya, Moi University, Eldoret, Kenya
- Simon Manyara, Moi University, Eldoret, Kenya
- Violet Naanyu, Moi University, Eldoret, Kenya
- Cleophas Wanyoni, Moi University, Eldoret, Kenya
- Naanyu, V., Vedanthan, R., Kamano, J. H., Rotich, J. K., Lagat, K. K., Kiptoo, P., Inui, T. S. (2016). Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study. Journal of general internal medicine, 1-11. doi:10.1007/s11606-015-3566-1
- Pastakia, S. D., Manyara, S. M., Vedanthan, R., Kamano, J. H., Menya, D., Andama, B., Laktabai, J. (2016). Impact of Bridging Income Generation with Group Integrated Care (BIGPIC) on Hypertension and Diabetes in Rural Western Kenya. Journal of general internal medicine, 1-9. doi:10.1007/s11606-016-3918-5