Tuesday, June 28, 2011

“Combating Chronic Diseases in India using Community Health Workers”, Blog 1

“Combating Chronic Diseases in India using Community Health Workers”
Bangalore, Karnataka, India
St. John's Research Institute 
Tanvir Hussain, MD, MSc

Blog 1: Project Background

On May 3, I returned to St. John’s Research Institute in Bangalore to continue working on the SPREAD Project.  The SPREAD project (Secondary Prevention of coronary Events After Discharge from hospital) is a randomized controlled trial in secondary prevention of acute coronary syndrome developed to serve the urban slums and rural village populations.  The design is an open trial comparing post-discharge interventions delivered by community health workers to standard care in 10 secondary and tertiary care hospitals. The objectives at the outset were to assess feasibility, estimate rates of adherence to pharmacotherapy, assess adherence to lifestyle modification, and obtain an estimate of the event rates in an Indian setting. 

SPREAD is an example of the response to changing disease burden globally.  As developing countries undergo epidemiologic transition and disease burden shifts from communicable disease towards chronic illnesses, current health delivery systems are being recognized as inadequate to manage CAD, DM, COPD, and cancer in low and middle income countries.  In 2009, the NIH provided funding to medical institutions in developing countries to implement innovative strategies in chronic disease care.  In India, where CVD is the leading cause of mortality in the urban and rural population, St. John's Institute of Bangalore is pioneering a community health worker (CHW) based secondary prevention model for CAD, the "SPREAD" project.

My role in the SPREAD project began during my six week global health elective funded by BWH Internal Medicine department during October through November 2010.  During this time, I enjoyed participating in the conceptualization of the intervention.  My role included working with experienced CHWs in producing a first draft of the CHW educational training materials.  I also produced a first draft of the patient encounter protocol for CHWs—that is, I developed a step-by-step tool CHWs could use during patient encounters to document and counsel patients during home visits, accessible to CHWs with primary school training. 

After I had left the project in the Fall of 2010, the team had taken several significant steps: identification of 14 potential study sites across India and a CHW at each site; translation of patient and CHW education materials into seven different languages (see pictures with Blog 1); training of the CHWs; evaluation of the CHWs; training of study sites for a non-“clinical” trial.  Conducting this process in several languages across fourteens sites was incredibly challenging.  And I was impressed by the team’s perseverance and accomplishments.  

Now that I had returned approximately eight months later, I was anxious to hear about the creative solutions created for the challenges faced by the team, the anecdotes and experiences bourn from the CHW trainings, the anticipations for the future, and more.  Part of my role on the project on this second visit would be to provide an assessment of the CHW training process to ensure the CHWs were adequately prepared to undertake the challenges of counseling and caring for post-MI patients from discharge to one year after their event, both at home and in the hospital.

In my next blog, I reflect on the unique challenges of employing a CHW model in chronic disease management, learnt from our project.


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