Endline Assessment of a Community-Based Program on Hypertension and Diabetes Management in Brazil

Background Brazil HealthRise community-based program focused on improving technologies for care coordination, developing the local workforce, and identifying and educating individuals with hypertension and diabetes. Objectives To assess the impact of HealthRise on hypertension and diabetes management among patients in the region of Teófilo Otoni (TO) and in the city of Vitória da Conquista (VC). Methods Grantees routinely collected patient-level clinical in intervention areas from March 2017 to December 2018; endline qualitative interviews were conducted with patients, providers, administrators, and policymakers in both intervention and comparison sites. Paired t-tests were employed to measure the potential impact of the program on reducing systolic blood pressure (SBP) and hemoglobin A1c (HbA1c) between baseline and endline, and on increasing the percentage of enrollees meeting clinical targets (SBP < 140 mmHg for hypertension; < 8% HbA1c for diabetes). We analyzed qualitative data using thematic coding. Results Across sites, 2,764 hypertension patients and 244 diabetes patients were followed through endline. Participants experienced reductions in SBP in TO (−1.9 mmHg [−3.1;−0.7]) and VC (−4,2 mmHg [−5.2;−3.1]); more hypertension patients met treatment targets in these locations (TO: +3.9 percentage-points [0.4;7.2]; VC: +10.5 percentage-points [7.81;13.2]) by endline. HbA1c decreased in TO (−0.6 [−0.9;−0.4]) and VC (−0.9 [−1.4;−0.5]), and more individuals presented HbA1c < 8% by endline (TO: +10.2 percentage-points [3.8, 16.6]; VC: +25 percentage-points [12.2, 37.8]). Qualitative data pointed to overall enthusiasm for new technologies and care routine implemented by HealthRise, but challenges regarding program implementation, integration with other levels of care, and social determinants of health persisted. Conclusions Program showed positive effects on hypertension and diabetes outcomes. Community-based health interventions can help bridge healthcare gaps, but their full impact will remain limited until multisectoral policies and actions address underlying structural and social determinants of health more effectively. ### Competing Interest Statement PB and JD are employees of the Medtronic Foundation. MTUB is a former Medtronic Foundation advisor. WWA, VMB, MALB, CCRC, MLC, PWE, CNK, MMOL, JAL, JXM, MSM, DSM, SM, JAQO, MGO, VSOAP, ALPR, DR, KOS, and DAS are recipients of HealthRise grants from the Medtronic Foundation to implement HealthRise interventions. LSF, SW, JNC, NF, KPH, CRM, MN, BKP, BT, and EG are recipients of funding from grants from the Medtronic Foundation to evaluate HealthRise interventions. ### Funding Statement Funding for the HealthRise project came from the Medtronic Foundation. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. This study was financed in part by the Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior - Brazil (CAPES) - Finance Code 001. JAQO and ALPR received support from the Instituto de Avaliacao de Tecnologia em Saude (IATS) and the Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq), Brazil. ALPR was supported in part by Fundacao de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG). MGO received funding from the Bahia State Research Support Foundation, the Federal University of Bahia, and the Municipal Health Secretariat of Vitoria da Conquista. Funders had no role in the study design, data collection, analysis, interpretation of data, or writing of the first draft of this manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The overall study was approved by the Institutional Review Board of the Human Subjects Division at the University of Washington. (Application Number: 51476) Institutional Review Board approval was also obtained for both quantitative and qualitative data collection from the Universidade Federal dos Vales do Jequitinhonha e Mucuri (CAAE:65808517.9.0000.5108 and CAAE:00865518.9.00005108) and the Universidade Federal da Bahia, Instituto Multidisciplinar em Saude-Campus Anisio Teixeira (CAAE:62259116.0.0000.5556 and CAAE:99216918.5.0000.5556). All personal identifiers were removed prior to the data being sent to IHME for analysis. Individuals participating in the study in Teofilo Otoni provided informed consent. Quantitative data from participants in Vitoria da Conquista were extracted from patient charts and no informed consent was required. All those participating in qualitative data collection activities provided informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.