Chronic Disease in the Community (CDCOM) Program: Hypertension and Noncommunicable Disease Care by Village Health Workers in Rural Uganda

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dc.contributor.authorStephens, Joseph H.
dc.contributor.authorAddepalliI, Aravind
dc.contributor.authorChaudhuri, Shombit
dc.contributor.authorNiyonzima, Abel
dc.contributor.authorMusominali, Sam
dc.contributor.authorUwamungu, Jean Claude
dc.contributor.authorPaccione, Gerald A.
dc.date.accessioned2022-04-20T16:26:59Z
dc.date.available2022-04-20T16:26:59Z
dc.date.issued2021
dc.description.abstractAlthough hypertension, the largest modifiable risk factor in the global burden of disease, is prevalent in sub-Saharan Africa, rates of awareness and control are low. Since 2011 village health workers (VHWs) in Kisoro district, Uganda have been providing non-communicable disease (NCD) care as part of the Chronic Disease in the Community (CDCom) Program. The VHWs screen for hypertension and other NCDs as part of a door-to-door biannual health census, and, under the supervision of health professionals from the local district hospital, also serve as the primary providers at monthly village-based NCD clinics. We describe the operation of CDCom, a 10-year comprehensive program employing VHWs to screen and manage hypertension and other NCDs at a community level. Using program records we also report hypertension prevalence in the community, program costs, and results of a cost-saving strategy to address frequent medication stockouts.Of 4283 people ages 30–69 screened for hypertension, 22% had a blood pressure (BP) ≥140/90 and 5% had a BP ≥ 160/100. All 163 people with SBP ≥170 during door-to-door screening were referred for evaluation in CDCom, of which 91 (59%) had repeated BP ≥170 and were enrolled in treatment. Of 761 patients enrolled in CDCom, 413 patients are being treated for hypertension and 68% of these had their most recent blood pressure below the treatment target. We find: 1) The difference in hypertension prevalence between this rural, agricultural population and national rates mirrors a rural-urban divide in many countries in sub-Saharan Africa. 2) VHWs are able to not only screen patients for hypertension, but also to manage their disease in monthly village-based clinics. 3) Mid-level providers at a local district hospital NCD clinic and faculty from an academic center provide institutional support to VHWs, stream-line referrals for complicated patients and facilitate provider education at all levels of care. 4) Selective stepdown of medication doses for patients with controlled hypertension is a safe, cost-saving strategy that partially addresses frequent stockouts of government-supplied medications and patient inability to pay. 5) CDCom, free for village members, operates at a modest cost of 0.20 USD per villager per year. We expect that our data-informed analysis of the program will benefit other groups attempting to decentralize chronic disease care in rural communities of low-income regions worldwide.en_US
dc.identifier.citationStephens, J. H., Addepalli, A., Chaudhuri, S., Niyonzima, A., Musominali, S., Uwamungu, J. C., & Paccione, G. A. (2021). Chronic Disease in the Community (CDCom) Program: hypertension and non-communicable disease care by village health workers in rural Uganda. PloS one, 16(2), e0247464.https://doi.org/10.1371/journal.pone.0247464en_US
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/2911
dc.language.isoenen_US
dc.publisherPloS oneen_US
dc.titleChronic Disease in the Community (CDCOM) Program: Hypertension and Noncommunicable Disease Care by Village Health Workers in Rural Ugandaen_US
dc.typeArticleen_US
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