JMIR Publications

ABSTRACT

Background:

Cardiovascular diseases were accountable for 24% of the total deaths in Cambodia, one of the lower and middle-income countries, where primary health care settings generally do not perform well in early detection, diagnosis, and monitoring of leading risk factors for cardiovascular diseases, that is, type 2 diabetes (T2D) and hypertension (HT). Integrated care for T2D and HT in the Cambodian primary health care system remains limited, with more than two-thirds of the population never having their blood glucose measured and more than half of the population with T2D not receiving treatment – few of them reaching recommended treatment targets. In regard to care for T2D and HT in the public health care system, there are three care models being scaled up including: (1) a hospital-based model, (2) a health center-based model, and (3) a community-based model. These three care models are implemented in isolation with relatively little interaction between each other. The question arises to what extent the three care models have performed in providing care to patients with T2D and/or HT in Cambodia.

Objective:

This protocol paper aims to show how to use primary data from a population-based survey to generate data for the cascades of care for assessing the continuum of care for T2D and HT across different care models.

Methods:

We adapt the HIV test-treat-retain cascade of care to assess the continuum of care for patients living with T2D and HT. The cascade-of-care approach outlines the sequential steps in long-term care: testing, diagnosis, linkage with care, retention in care, adherence to treatment, and reaching treatment targets. Five operational districts (ODs) in different provinces will be purposefully selected out of 103 ODs across the country. The population-based survey will follow a multistage stratified random cluster sampling, with expected recruitment of 5,280 eligible individuals aged 40 and over as the total sample size. Data collection process will follow the STEPS survey approach, with modification of the sequence of the steps in order to adapt the data collection to the study context. There are three main steps of data collection: (1) structured interviews with questionnaires, (2) anthropometric measurements, and (3) biochemical measurements.

Results:

As of December 2021, the recruitment process was completed, with 5,072 eligible individuals participating in the data collection, but data analysis is not completed. Results are expected to be fully available in mid-2022.

Conclusions:

The cascade of care will allow us to identify the leakages in the system and identify unmet need for care. Identifying gaps in the health system is vital to improve efficiency and effectiveness of its performance. This study protocol and its expected results will help implementers and policy makers to assess scale up and adapt strategies for T2D and HT care in Cambodia. Clinical Trial: International Standard Randomised Controlled Trials Number (ISRCTN) registry, number 37447 (first date of publication 3 February 2020)