JMIR Publications

ABSTRACT

Background:

- India has a massive non-communicable disease (NCD) burden at an enormous cost to the individual, family, society and health system at large, in spite of which prevention and surveillance is relatively neglected. Risk factors for atherosclerotic cardiovascular disease if diagnosed early and treated adequately would help decrease the mortality and morbidity burden. India is in a stage of rapid epidemiological transition with the state of Kerala being at the forefront, pointing us towards likely disease burden and outcomes for the rest of the country, in the future. A previous study done by the same investigators, in a population of >100000, revealed poor awareness and treatment of NCDs and also poor adherence to medicines in individuals with CVD.

Objective:

The investigators are looking at a sustainable, community based model of surveillance for NCDs with corporate support wherein frontline health workers check all individuals in the target group ( > age 30 years) for NCDs including blood pressure, plasma glucose and Body mass Index (BMI) as an initial screen with further follow up and treatment planned in a “spoke and hub” model using the public health system of primary health centres (PHCs) as spokes to the hubs of taluk or district hospitals. The total population under surveillance is 1.3 million of whom 800000 would be actively screened (target group, age > 30 years).

Methods:

Initial data entry and primary screening would be done by frontline health workers in respective houses of those screened and entered on a Tab PC ensuring rapid acquisition and transfer of participant health details to PHCs for further follow up and treatment. The model will be evaluated based on the utilisation rate of various services offered at all tier levels. The proportions of the target population screened, eligible individuals who reached the spoke or hub centres for risk stratification and care and community level control for hypertension and diabetes in annual surveys will be used as indicator variables. The model ensures diagnosis and follow up treatment at no cost to the individual entirely through the tiered public health system of the state and country.

Results:

We have completed surveillance in 23 of the 27 panchayats (villages) and 1 of the 3 municipalities as of January 2021. The ethical approval for the study was obtained in December 2017. The sanction letter was released in March 2018 with transfer of the first tranche of funds in April 2018. The study got underway on the 27th July 2018 with the training for the first set of frontline health workers. The study was delayed considerably first by a major flood in the area in August and September of 2018 and then the SARS-CoV-2 pandemic over the last year 2020-21.

Conclusions:

The spoke and hub model using frontline health workers for initial screening at respective houses, follow up at the PHC level and medicines in the needy at no cost to the individual through the public health system is an eminently implementable and sustainable model for India and other LMICs. Clinical Trial: The study is registered under the Clinical Trial Registry India, registration number - CTRI/2018/07/014856. The surveillance model is NOT a clinical trial. http://ctri.nic.in/Clinicaltrials/advsearch.php