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Bridging Income Generation with Group Integrated Care for cardiovascular risk reduction: Rationale and design of the BIGPIC study.

Publication ,  Journal Article
Vedanthan, R; Kamano, JH; Lee, H; Andama, B; Bloomfield, GS; DeLong, AK; Edelman, D; Finkelstein, EA; Hogan, JW; Horowitz, CR; Manyara, S ...
Published in: Am Heart J
June 2017

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with >80% of CVD deaths occurring in low and middle income countries (LMICs). Diabetes mellitus and pre-diabetes are risk factors for CVD, and CVD is the major cause of morbidity and mortality among individuals with DM. There is a critical period now during which reducing CVD risk among individuals with diabetes and pre-diabetes may have a major impact. Cost-effective, culturally appropriate, and context-specific approaches are required. Two promising strategies to improve health outcomes are group medical visits and microfinance. METHODS/DESIGN: This study tests whether group medical visits integrated into microfinance groups are effective and cost-effective in reducing CVD risk among individuals with diabetes or at increased risk for diabetes in western Kenya. An initial phase of qualitative inquiry will assess contextual factors, facilitators, and barriers that may impact integration of group medical visits and microfinance for CVD risk reduction. Subsequently, we will conduct a four-arm cluster randomized trial comparing: (1) usual clinical care, (2) usual clinical care plus microfinance groups only, (3) group medical visits only, and (4) group medical visits integrated into microfinance groups. The primary outcome measure will be 1-year change in systolic blood pressure, and a key secondary outcome measure is 1-year change in overall CVD risk as measured by the QRISK2 score. We will conduct mediation analysis to evaluate the influence of changes in social network characteristics on intervention outcomes, as well as moderation analysis to evaluate the influence of baseline social network characteristics on effectiveness of the interventions. Cost-effectiveness analysis will be conducted in terms of cost per unit change in systolic blood pressure, percent change in CVD risk score, and per disability-adjusted life year saved. DISCUSSION: This study will provide evidence regarding effectiveness and cost-effectiveness of interventions to reduce CVD risk. We aim to produce generalizable methods and results that can provide a model for adoption in low-resource settings worldwide.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2017

Volume

188

Start / End Page

175 / 185

Location

United States

Related Subject Headings

  • Young Adult
  • Risk Reduction Behavior
  • Risk Factors
  • Retrospective Studies
  • Primary Prevention
  • Male
  • Kenya
  • Income
  • Incidence
  • Humans
 

Citation

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Vedanthan, R., Kamano, J. H., Lee, H., Andama, B., Bloomfield, G. S., DeLong, A. K., … Fuster, V. (2017). Bridging Income Generation with Group Integrated Care for cardiovascular risk reduction: Rationale and design of the BIGPIC study. Am Heart J, 188, 175–185. https://doi.org/10.1016/j.ahj.2017.03.012
Vedanthan, Rajesh, Jemima H. Kamano, Hana Lee, Benjamin Andama, Gerald S. Bloomfield, Allison K. DeLong, David Edelman, et al. “Bridging Income Generation with Group Integrated Care for cardiovascular risk reduction: Rationale and design of the BIGPIC study.Am Heart J 188 (June 2017): 175–85. https://doi.org/10.1016/j.ahj.2017.03.012.
Vedanthan R, Kamano JH, Lee H, Andama B, Bloomfield GS, DeLong AK, et al. Bridging Income Generation with Group Integrated Care for cardiovascular risk reduction: Rationale and design of the BIGPIC study. Am Heart J. 2017 Jun;188:175–85.
Vedanthan, Rajesh, et al. “Bridging Income Generation with Group Integrated Care for cardiovascular risk reduction: Rationale and design of the BIGPIC study.Am Heart J, vol. 188, June 2017, pp. 175–85. Pubmed, doi:10.1016/j.ahj.2017.03.012.
Vedanthan R, Kamano JH, Lee H, Andama B, Bloomfield GS, DeLong AK, Edelman D, Finkelstein EA, Hogan JW, Horowitz CR, Manyara S, Menya D, Naanyu V, Pastakia SD, Valente TW, Wanyonyi CC, Fuster V. Bridging Income Generation with Group Integrated Care for cardiovascular risk reduction: Rationale and design of the BIGPIC study. Am Heart J. 2017 Jun;188:175–185.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2017

Volume

188

Start / End Page

175 / 185

Location

United States

Related Subject Headings

  • Young Adult
  • Risk Reduction Behavior
  • Risk Factors
  • Retrospective Studies
  • Primary Prevention
  • Male
  • Kenya
  • Income
  • Incidence
  • Humans