Acceptability and Feasibility of Interventions for Integrated Care of Chronic Kidney Disease With Other Long-term Health Conditions in Malawi: a Qualitative Study

NCT ID: NCT06807567

Last Updated: 2025-02-04

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Total Enrollment: 60 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2025-02-17
• Study Completion Date: 2026-03-05

Brief Summary

The burden of chronic kidney disease (CKD) is rising globally, but disproportionately impacting on low- and middle-income countries (LMIC) including Malawi, which have the fewest resources to manage it. Furthermore, CKD is the leading cause of catastrophic health expenditure worldwide, largely due to the extremely high costs of kidney replacement therapy (KRT) for people with kidney failure. Access to KRT remains limited in many settings, including Malawi, where there is only one nephrologist for a population of over 21 million. It is therefore essential to diagnose and treat CKD in its early stages, to facilitate earlier and more cost-effective treatment to prevent its progression to advanced disease which is associated with increased risks of kidney failure and of cardiovascular morbidity and mortality. CKD is usually asymptomatic in its early stages, so early diagnosis and treatments requires access to key diagnostic tests, in addition to strategies for channelling resources to those at the highest risk.

The causes of CKD are diverse, particularly in LMIC settings where the increasing prevalence of non-communicable diseases intersects with ongoing high burdens of infectious diseases, malnutrition, and many other social and environmental determinants of kidney health. The World Health Organization recommends integrated approaches to improve equity of quality care for people living with long-term conditions, and CKD would be amenable to integrated approaches, however CKD has been neglected from global NCD agendas and there is little data to guide the most effective methods for integrating its care with other long-term conditions (such as hypertension, diabetes and HIV infection), particularly in low-income settings such as Malawi.

The aim of this study is to explore current experiences of care for CKD and related long-term conditions, and to qualitatively evaluate the acceptability and feasibility of different potential approaches to integrating their care, amongst different stakeholders groups in Malawi.

Conditions

Chronic Kidney Disease(CKD); Multimorbidity; Long-term Health Conditions

Study Design

• Observational Model Type: OTHER
• Study Time Perspective: OTHER

Study Groups

Patients and caregivers

Patients aged 18 years and over with CKD, or at risk of CKD, who have at least one other long-term condition, and who are receiving care at either Queen Elizabeth Central Hospital in Blantyre, Chiradzulu District Hospital, Namadzi or Ndunde primary health care centres. Caregivers will be the caregivers of patients meeting these conditions.

Receipt of healthcare for long-term conditions

Intervention Type: OTHER

The patient participants are people who are already receiving healthcare for CKD and/or hypertension, diabetes, HIV, heart failure and/or stroke at one of the named study sites, for at least 6 months prior to recruitment into this qualitative study. The caregiver participants are caregivers for patients meeting these criteria.

Healthcare workers

Healthcare workers, aged 18 years and over, providing care for patients with CKD and other long-term health conditions at Queen Elizabeth Central Hospital in Blantyre, Chiradzulu District Hospital, Namadzi or Ndunde primary health care centres.

Provision of healthcare

Intervention Type: OTHER

The healthcare worker participants are all providing care to patients with long-tem conditions, at one of the names study sites

Policy makers

Policy makers with roles in policy making related to CKD and other long-term health conditions in Malawi.

Policy making

Intervention Type: OTHER

The policy makers recruited to this study will be individuals involved in policy making for long-term conditions in Malawi

Interventions

Receipt of healthcare for long-term conditions

The patient participants are people who are already receiving healthcare for CKD and/or hypertension, diabetes, HIV, heart failure and/or stroke at one of the named study sites, for at least 6 months prior to recruitment into this qualitative study. The caregiver participants are caregivers for patients meeting these criteria.

Intervention Type: OTHER

Provision of healthcare

The healthcare worker participants are all providing care to patients with long-tem conditions, at one of the names study sites

Intervention Type: OTHER

Policy making

The policy makers recruited to this study will be individuals involved in policy making for long-term conditions in Malawi

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Eligibility criteria for each of the participant groups described above are as follows:

Patients:

1. Adults aged ≥ 18 years

2. Diagnosed with CKD, or at risk of CKD, AND at least one other long-term health condition out of:

• Hypertension
• Diabetes mellitus
• HIV infection
• Heart failure

3. Receiving outpatient care at one of the selected study sites, for at least 6 months

Caregivers:

1. Adults aged ≥ 18 years

Healthcare workers:

• Adults aged ≥ 18 years
• Currently employed as a healthcare worker at either QECH, Chiradzulu District Hospital, Ndunde Health Centre or Namadzi Health Centre.
• Working in an outpatient clinic environments where care is delivered for patients with any of the above conditions, which may include (but is not limited to) the following:

• CKD clinic (QECH)
• Hypertension clinic (QECH)
• Diabetes clinic (QECH)
• HIV clinic (all study locations, including the Lighthouse clinic at QECH)
• Cardiology /chest clinic (QECH)
• General non-communicable disease (Chiradzulu District Hospital and its referring primary health centres)

Policy makers

• Adults aged ≥ 18 years
• Identified through stakeholder mapping and/or snowball sampling to have a leading role relevant to planning, managing and implementing services and/or policies for NCDs and/or other LTCs.

Exclusion Criteria

• • Under 18 years of age

• Acute physical or mental illness, which requires urgent treatment and might impact on ability to participate in and complete interview
• Current hospital inpatient
• Unable to participate in interview due to severe communication difficulties (e.g. aphasia), confusion or behavioural disturbance
• Declines consent

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Wellcome Trust (Liverpool Clinical PhD Programme)

UNKNOWN

Sponsor Role: collaborator

Liverpool School of Tropical Medicine

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Malawi Liverpool Wellcome Clinical Research Programme

Blantyre, , Malawi

Countries

Malawi

Facility Contacts

Brian Ngwira

Role: primary

bngwira@mlw.mw

+265 993888275

Charlotte M Snead

Role: backup

charlotte.snead@lstmed.ac.uk

Other Identifiers

24-057

Identifier Type: -

Identifier Source: org_study_id