NIHR Global Health Research Group on collaborative care for cardiometabolic disease in Africa

Research question

Can a model of care based on the chronic care model (CCM) and collaborative care model (CoCM) sustainably improve cardiometabolic health in low-to-middle income countries? Background

Non-communicable diseases are rising in sub-Saharan Africa, mainly driven by cardiometabolic disease (CMD; cardiovascular disease, diabetes, hypertension). From a patient and healthcare systems perspective, it is more effective and efficient to have a cohesive approach to caring for CMDs given their shared aetiology and management. Based on unmet needs, local context, and evidence gaps, this Group will focus on CMD management in 3 ODA-eligible sub-Saharan African countries.

Aim

Develop a CCM and CoCM model of care to improve care, outcomes and risk factor control for adults with CMD in Ghana, Kenya, and Mozambique in the COVID-19-era and beyond to contribute to the UN Sustainable Development Goals of promoting good health/well-being and reducing poverty/inequalities. Objectives

WP1: Identify and prioritise healthcare needs and available resources to support model development. WP2: Iteratively develop a model for people with CMD that is ready for implementation in SSA.

WP3: Investigate the practical implications of delivering the model developed in WP2 and parameters required to design a randomised controlled trial.

WP4: Maximise impact, uptake and implementation of the Group activities, by putting in place enablers to secure sustainability beyond the funding. Methods

WP1: Comprehensive literature review, scoping analysis (workshops) and needs assessment (quantitative analysis of existing data; qualitative analysis of focus groups) to create a Theory of Change.

WP2: Engage with local communities to create and/or culturally adapt existing elements of the intervention, including a self-management programme, training packages for educators to deliver it, and a training programme to upskill healthcare professionals and community workers.

WP3: A mixed-methods single-arm feasibility study (5 sites across the 3 countries; ~260 patient-participants plus healthcare professional and community leader participants).

WP4: Develop an implementation plan, engage in knowledge mobilisation activities, co-develop a sustainability plan for the Group, and design an RCT.

Theme 1: Implement a training and capacity building programme to develop future leaders in research management and expertise in SSA.

Theme 2: Establish and expand a programme of community engagement and involvement (CEI) to deliver clear and effective involvement and engagement strategies, which will shape the delivery of this research programme, maximise impact and build lasting capacity to support CEI in future research. Timelines

WP1 (Prefunding-12); WP2 (M7-21); WP3 (M7-36); WP4, T1, T2 (M1-36). Impact and Dissemination

The primary impact will be a substantial improvement in cardiometabolic health for those living in Ghana, Kenya and Mozambique. Academic and non-academic outputs will be disseminated through well-established methods, including press releases, social networks, open days, and relevant charities. Wider effects include improved research and community engagement and involvement capacity.

These benefits will likely translate to substantial economic benefits for the local healthcare providers, patients, and health systems.