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

BackgroundBrazil HealthRise community-based program focused on improving technologies for care coordination, developing the local workforce, and identifying and educating individuals with hypertension and diabetes. ObjectivesTo assess the impact of HealthRise on hypertension and diabetes management among patients in the region of Teofilo Otoni (TO) and in the city of Vitoria da Conquista (VC). MethodsGrantees 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. ResultsAcross 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. ConclusionsProgram 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.