IDF21-0661 Addressing diabetes and hypertension through an innovative, community-based, and people centered model

Abstract

Background: In Vietnam, noncommunicable diseases (NCDs) account for 77% of all deaths. Diabetes and hypertension (HTN) are leading contributors to the country’s NCD burden and many people remain undiagnosed. The 2015 WHO STEPS survey indicated that 18.9% of those surveyed had hypertension, but only 43.1% detected at screening were aware of their status. Of these, just 13.6% reported that their blood pressure (BP) was being managed at a health facility. The significant gaps in the treatment cascade are attributed to limited awareness, limited health care worker capacity at the primary health care (PHC) level, and lack of convenient access to screening, prevention, and adherence counselling. In 2016, PATH and the Novartis Foundation, collaborated with the Ho Chi Minh City Municipal Health Department and the General Department of Preventive Medicine (GDPM) to launch the Communities for Healthy Hearts program in Ho Chi Minh City. In 2019, with funding from Access Accelerated, the program expanded to three provinces and included diabetes screening and linkage to care. Aim: The project’s overarching goal is to improve diabetes and hypertension awareness, screening, diagnosis, treatment, and case management amongst adults over 40. Method: The project’s methodology is centered around increasing (1) diabetes and hypertension awareness and health seeking demand, (2) access to quality patient–centered services for diabetes and hypertension at the PHC level, and (3) retention in care. The model was designed in partnership with the Ministry of Health and local partners based on findings from a targeted audience assessment and informed by the global HEARTS technical package, the Expanded Chronic Care Model, and the Framework on Integrated People-Centered Health Services. Results: From 2016-2019 the program screened 121,273 people over 40. Of those screened, 24.7% were at risk for hypertension, 55% were diagnosed, 57% were treated, and 57% of those treated reached the target blood pressure. The number of people with hypertension listed at Commune Health Stations increased 20 times, from 800 people to 16,455 people. From October 2019 to March 2021, 93,425 adults over 40 were screened for diabetes and HTN. Of those screened, 32.7% had elevated blood pressure and/or were considered at risk for diabetes and were referred to health facilities. Of those referred, 51.3% were diagnosed with hypertension, and 0.6% with diabetes. Of those confirmed, 93.8% were treated. Of those treated, 80.5% achieved blood pressure control and 77.1% achieved blood glucose control, an improvement from past programs. Discussion: The program’s unique multi-pronged model that included public-sector health services as well as private partnerships, extension of services to convenient community locations, capacity building for health workers and community volunteers, and the use of digital technologies to raise awareness and ensure linkage to care, resulted in increased screening and retention rates as compared to national averages. The project found that early diagnosis, greater proportion of patients initiating treatment, and improved control were supported by system-level interventions. The combined interventions that made up the model were a first step in Vietnam towards a differentiated care approach for NCDs that is sustainable and scalable.