TY - JOUR T1 - Community-based interventions for detection and management of diabetes and hypertension in underserved communities: a mixed-methods evaluation in Brazil, India, South Africa and the USA JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2019-001959 VL - 5 IS - 6 SP - e001959 AU - Luisa S Flor AU - Shelley Wilson AU - Paurvi Bhatt AU - Miranda Bryant AU - Aaron Burnett AU - Joseph N Camarda AU - Vasudha Chakravarthy AU - Chandrashekhar Chandrashekhar AU - Nayanjeet Chaudhury AU - Christiane Cimini AU - Danny V Colombara AU - Haricharan Conjeevaram Narayanan AU - Matheus Lopes Cortes AU - Krycia Cowling AU - Jessica Daly AU - Herbert Duber AU - Vinayakan Ellath Kavinkare AU - Patrick Endlich AU - Nancy Fullman AU - Rose Gabert AU - Thomas Glucksman AU - Katie Panhorst Harris AU - Maria Angela Loguercio Bouskela AU - Junia Maia AU - Charlie Mandile AU - Milena S Marcolino AU - Susan Marshall AU - Claire R McNellan AU - Danielle Souto de Medeiros AU - Sóstenes Mistro AU - Vasudha Mulakaluri AU - Jennifer Murphree AU - Marie Ng AU - J A Q Oliveira AU - Márcio Galvão Oliveira AU - Bryan Phillips AU - Vânia Pinto AU - Tara Polzer Ngwato AU - Tia Radant AU - Marissa B Reitsma AU - Antonio Luiz Ribeiro AU - Gregory Roth AU - Davi Rumel AU - Gaurav Sethi AU - Daniela Arruda Soares AU - Tsega Tamene AU - Blake Thomson AU - Harsha Tomar AU - Mark Thomaz Ugliara Barone AU - Sameer Valsangkar AU - Alexandra Wollum AU - Emmanuela Gakidou Y1 - 2020/06/01 UR - http://gh.bmj.com/content/5/6/e001959.abstract N2 - Introduction As non-communicable disease (NCD) burden rises worldwide, community-based programmes are a promising strategy to bridge gaps in NCD care. The HealthRise programme sought to improve hypertension and diabetes management for underserved communities in nine sites across Brazil, India, South Africa and the USA between 2016 and 2018. This study presents findings from the programme’s endline evaluation.Methods The evaluation utilises a mixed-methods quasi-experimental design. Process indicators assess programme implementation; quantitative data examine patients’ biometric measures and qualitative data characterise programme successes and challenges. Programme impact was assessed using the percentage of patients meeting blood pressure and A1c treatment targets and tracking changes in these measures over time.Results Almost 60 000 screenings, most of them in India, resulted in 1464 new hypertension and 295 new diabetes cases across sites. In Brazil, patients exhibited statistically significant reductions in blood pressure and A1c. In Shimla, India, and in South Africa, country with the shortest implementation period, there were no differences between patients served by facilities in HealthRise areas relative to comparison areas. Among participating patients with diabetes in Hennepin and Ramsey counties and hypertension patients in Hennepin County, the percentage of HealthRise patients meeting treatment targets at endline was significantly higher relative to comparison group patients. Qualitative analysis identified linking different providers, services, communities and information systems as positive HealthRise attributes. Gaps in health system capacities and sociodemographic factors, including poverty, low levels of health education and limited access to nutritious food, are remaining challenges.Conclusions Findings from Brazil and the USA indicate that the HealthRise model has the potential to improve patient outcomes. Short implementation periods and strong emphasis on screening may have contributed to the lack of detectable differences in other sites. Community-based care cannot deliver its full potential if sociodemographic and health system barriers are not addressed in tandem. ER -