Community Health Workers Led Integrated Management of Hypertension and Diabetes in Nepal

Summary

Hypertension (HTN) and diabetes mellitus are significant global public health challenges, contributing to 13.5% of premature deaths, 54% of incident strokes, and 47% of coronary heart disease cases (HTN), and increasing risks of cardiovascular diseases, kidney failure, and other complications (diabetes). In Nepal, HTN prevalence is 24.5% and diabetes affects 5.8% of adults (2019 Nepal STEPS Survey), with many cases undiagnosed or poorly managed, and an estimated 60% co-morbidity among diabetic individuals. Nepal's Package of Essential Non-Communicable Diseases (PEN), implemented since 2017, targets both conditions, but multi-level barriers limit its facility-based effectiveness. This study addresses the need for cost-effective, evidence-based strategies for HTN and diabetes management in low-resource settings, focusing on marginalized populations. It proposes a Type II hybrid implementation-effectiveness study with two objectives: (1) evaluate implementation outcomes (reach, adoption, implementation, maintenance) of the Female Community Health Volunteers (FCHVs)-led integrated HTN and diabetes management using the RE-AIM framework; (2) assess effectiveness compared to facility-based PEN on systolic blood pressure and fasting blood sugar at 12 months. FCHVs will deliver integrated health education, form peer groups, and coordinate care. Using a mixed-method approach, the study involves a cluster randomized controlled trial with participants, collecting quantitative data on implementation, supplemented by in-depth interviews (8-16 patients) and focus group discussions (2 FGDs with FCHVs), with qualitative tracking logs. The intervention adapts a prior FCHV-led HTN trial to integrate diabetes management. FCHVs will receive 3-day training on screening, counseling, BP and blood sugar monitoring, and referrals for both conditions. Mass screening will identify HTN and diabetes cases, forming monthly FCHV groups for lifestyle counseling, BP, and glucose tracking, with family involvement. Monthly referrals will link uncontrolled cases to facilities. This aims to enhance integrated HTN and diabetes management, fostering community engagement and healthcare coordination, with findings to inform scalable NCD strategies in Nepal.

Conditions

• Hypertension (HTN)
• Diabetes (DM)

Interventions

BEHAVIORAL

Integrated management of hypertension and diabetes using group care approach

FCHVs will undergo a 3-day training program on HTN and DM management, including screening, counseling, medication adherence, self-care, and referrals. They will then collaborate with healthcare facilities to conduct one-day hypertension screening camps(outreach clinics). FCHVs will form groups for individuals with hypertension and hold monthly meetings 1-3 days prior to outreach clinic by health facilities to discuss control strategies, review BPlogs, and promote healthcare visits, including family involvement identify uncontrolled and refer to outreach clinics. They will also conduct home visits to those who are not able to join the group care session and also maintain regular communication with health facilities.

Sponsors & Collaborators

• Institute for Implementation Science and Health

  collaborator UNKNOWN

• World Health Organization

  collaborator OTHER

• Kathmandu University School of Medical Sciences

  lead OTHER

Principal Investigators

• Archana Shrestha, PhD · Kathmandu University School of Medical Sciences

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

30 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-12-14

Primary Completion

2027-11-30

Completion

2027-11-30

Countries

• Nepal

Study Locations