Strengthening Primary Healthcare Delivery for Diabetes and Hypertension in Eswatini

NCT ID: NCT04183413

Last Updated: 2024-10-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

3500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-11-01

Study Completion Date

2023-12-31

Brief Summary

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The WHO-PEN@Scale project is a three-arm cluster-randomized trial that is investigating the population-level effects of a healthcare reform in Eswatini, which aims to strengthen primary care for diabetes and hypertension. Prior to the reform, healthcare for diabetes and hypertension was mostly provided through physician-led teams in hospital outpatient departments. The healthcare reform aims to strengthen the provision of nurse-led care for diabetes and hypertension in primary healthcare facilities and community health worker-led care for these conditions in the facilities' catchment areas. The reform will broadly be guided by the World Health Organization's "Package of Essential Noncommunicable Disease Interventions for Primary Health Care in Low-Resource Settings" (WHO-PEN). The trial will take place at 84 clusters (a primary healthcare facility and its catchment area) across the country.

Detailed Description

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Conditions

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Diabetes Mellitus Hypertension

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This is a parallel three-arm cluster-randomized trial without a baseline assessment.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Standard of Care

Health services for diabetes and hypertension are provided as was the standard of care prior to the healthcare reform after the emergency decentralization motivated by the COVID-19 outbreak. Healthcare for diabetes and hypertension for complicated cases is provided through physician-led teams at hospitals and health centers. Healthcare for diabetes and hypertension for uncomplicated cases is provided at primary care clinics through nurses.

Group Type NO_INTERVENTION

No interventions assigned to this group

DSD

Clients are invited to participate in one of three Differentiated Service Delivery models tailored to their needs.

Group Type EXPERIMENTAL

DSD

Intervention Type OTHER

This intervention consist of three Differentiated Service Delivery Models in which stable clients can be enrolled. The fast-track model gives preferential treatment to enrolled clients. Clients arrive at clinics, usually early in the morning, and can see the nurse as well as collect their medication without queuing. This model mainly targets the working population. The facility-based treatment clubs consist of bimonthly meetings where clients meet in groups of approximately 20 members. They receive health counselling, risk factor screening and medication prescription. This model mainly targets clients living close to the facility. The community advisory groups consist of groups of up to six clients. Groups are equipped with a point of care blood pressure and blood glucose measurement devices. They take turns in collecting the medication for the entire group and meet on a monthly basis. This model targets clients in hard-to-reach areas.

CDP

Health services for diabetes and hypertension are provided in the scope of outreach activities set up on a monthly basis in communities.

Group Type EXPERIMENTAL

CDP

Intervention Type OTHER

Community Distribution Points are set up on a monthly basis in communities linked to the clinic. Healthcare staff sets up a temporary point of contact where clients can obtain screening for diabetes and hypertension, health counselling, referral to primary or tertiary facilities, and medication.

Interventions

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DSD

This intervention consist of three Differentiated Service Delivery Models in which stable clients can be enrolled. The fast-track model gives preferential treatment to enrolled clients. Clients arrive at clinics, usually early in the morning, and can see the nurse as well as collect their medication without queuing. This model mainly targets the working population. The facility-based treatment clubs consist of bimonthly meetings where clients meet in groups of approximately 20 members. They receive health counselling, risk factor screening and medication prescription. This model mainly targets clients living close to the facility. The community advisory groups consist of groups of up to six clients. Groups are equipped with a point of care blood pressure and blood glucose measurement devices. They take turns in collecting the medication for the entire group and meet on a monthly basis. This model targets clients in hard-to-reach areas.

Intervention Type OTHER

CDP

Community Distribution Points are set up on a monthly basis in communities linked to the clinic. Healthcare staff sets up a temporary point of contact where clients can obtain screening for diabetes and hypertension, health counselling, referral to primary or tertiary facilities, and medication.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Residing in one of the selected households
* Age ≥40 years

Exclusion Criteria

* Pregnant
* Inability to provide written informed consent
Minimum Eligible Age

40 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Amsterdam Institute for Global Health and Development

OTHER

Sponsor Role collaborator

Swiss Tropical & Public Health Institute

OTHER

Sponsor Role collaborator

Clinton Health Access Initiative, Eswatini

UNKNOWN

Sponsor Role collaborator

University of Göttingen

OTHER

Sponsor Role collaborator

University of Eswatini

UNKNOWN

Sponsor Role collaborator

SWABCHA, Eswatini

UNKNOWN

Sponsor Role collaborator

Diabetes Swaziland

UNKNOWN

Sponsor Role collaborator

University Hospital Heidelberg

OTHER

Sponsor Role lead

Responsible Party

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Till Bärnighausen

Prof. Dr. Dr. Till Bärnighausen

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Pascal Geldsetzer, MD ScD MPH

Role: PRINCIPAL_INVESTIGATOR

Stanford University

Jan-Walter De Neve, MD ScD MPH

Role: PRINCIPAL_INVESTIGATOR

Heidelberg Institute of Global Health, Heidelberg University

Locations

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Clinton Health Access Initiative

Mbabane, , Eswatini

Site Status

Countries

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Eswatini

References

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Harkare HV, Osetinsky B, Ginindza N, Cindzi BT, Mncina N, Akomolafe B, Marowa LR, Ntshalintshali N, Tediosi F. Human and financial resource needs for universal access to WHO-PEN interventions for diabetes and hypertension care in Eswatini: results from a time-and-motion and bottom-up costing study. Hum Resour Health. 2024 May 27;22(1):32. doi: 10.1186/s12960-024-00913-0.

Reference Type DERIVED
PMID: 38802811 (View on PubMed)

Theilmann M, Ginindza N, Myeni J, Dlamini S, Cindzi BT, Dlamini D, Dlamini TL, Greve M, Harkare HV, Hleta M, Khumalo P, Kolbe LM, Lewin S, Marowa LR, Masuku S, Mavuso D, Molemans M, Ntshalintshali N, Nxumalo N, Osetinsky B, Pell C, Reis R, Shabalala F, Simelane BR, Stehr L, Tediosi F, van Leth F, De Neve JW, Barnighausen T, Geldsetzer P. Strengthening primary care for diabetes and hypertension in Eswatini: study protocol for a nationwide cluster-randomized controlled trial. Trials. 2023 Mar 22;24(1):210. doi: 10.1186/s13063-023-07096-4.

Reference Type DERIVED
PMID: 36949485 (View on PubMed)

Provided Documents

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Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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WHO-PEN@Scale

Identifier Type: -

Identifier Source: org_study_id

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