Since 1978, Lesotho has an existing CHW program that focuses on HIV and maternal health and the community health system is not digitized. The prevalence of non communicable diseases such as diabetes and hypertension has been on the rise in Lesotho, to improve the health outcomes; the ComBaCal model of care is being implemented through the task shifting of primary level care to CHWs who have been empowered with a CHT based digital tool and other equipment required to support them to deliver NCD care. The ComBaCal intervention was piloted within a cohort of 10 villages then scaled to the main cohort of 100 villages. This is a randomized controlled trial, where CHWs are involved in diabetes and hypertension screening, diagnosis and treatment with different care packages in intervention and control groups. CHWs working in the 50 control villages use CHT to screen, diagnose and refer patients to facilities for further management. CHWs working in the 50 intervention villages have access to treatment components of the app algorithm to allow them to precribe first line antihypertensive and diabetic medication and based on cardiovascular risk assessments they can also prescribe aspirin and lipid lowering drugs.
Research data points were incorporated into the app algorithm. Clients consented to participate in this study, baseline was done to determine eligibility and a revised chronic care form was used to screen clients. The data from the screening form were used to calculate the study and clinical statuses. For chronic care, previous data was required for treatment decisions. For this study, the team defined a set of variables that were preloaded in each form code, time dependent skip logic was introduced to avoid redundant questions in repeating forms. Preliminary findings after implementing this study for a year show that 7763 (98%) of patients who were eligible for hypertension screening have been screened. 1330 (17%) of those screened were diagnosed with hypertension, 653 of the diagnosed patients are living in the intervetion site and are being managed under the VHW care. In addition to the clinical intervention, the ComBaCal team has also conducted various usability tests of the use of CHT in delivering NCD care. The findings from the usability tests show that 98% of the CHT users find it is easy to diagnose hypertension and diabetes using CHT versus 64% of the users who preferred the manual process. During the usability tests, the team also conducted system usability score tests, CHT was averagely scored at 76% (good usability), the users however mentioned that CHT required significant initial training for users.
Thank you @felixgerber and the ComBaCal team for the exceptional presentation, the ComBaCal Community Story presentation video has been uploaded here.