India

Figure 6. Vitória da Conquistacascade of care

More males than females were “Newly screened, ” “Newly screened positive,

” and “Newly diagnosed” for hypertension; however, females considerably outnumbered males in the “Enrolled,” “Biomarker,” and “Controlled” categories for hypertension. For diabetes, females outnumber males in all categories from “Screened” to “Controlled.” Tables containing disaggregated counts by sex, category, and disease can be found in Appendix D.

India

Patient empowerment and community engagement were prominent intervention approaches by both grantees in India. Along with support groups for patients and their families in or close to their communities, grantees partnered with Constellation to introduce an appreciative listening technique – SALT – which was implemented in 14 villages in the Shimla intervention area and four villages in the Udaipur intervention area.

The grantees were also keen on screening and finding new individuals at risk of having hypertension, diabetes, or both. A total of 48,612 individuals were screened, and individuals suspected of having either condition were referred to a health facility for confirmatory diagnosis.

Udaipur

In an attempt to identify individuals at risk, CHAI organized 128 screening events which were open to both those aware and not aware of their condition. CHAI also conducted household screening events to meet screening targets. A total of 26,559 individuals were screened for hypertension, and 18,166 individuals were screened for diabetes; Of those individuals, 26,144 individuals who were screened for elevated blood pressure reported no previous diagnosis of hypertension, and 17,994 individuals who were screened for elevated blood sugar reported no previous diagnosis of diabetes. The cascade of care below describes the number of individuals at various stages of identification and treatment for hypertension and diabetes. Categories containing the label “Newly” exclude individuals with pre-existing diagnoses for a given condition (Figure 7).

Figure 7. Udaipurcascade of care

835 individuals who reported no previous diagnosis of hypertension were identified through the screening process as having elevated blood pressure and were referred to a health facility for a confirmatory diagnosis; 264 individuals who reported no previous diagnosis of hypertension received a confirmatory diagnosis of hypertension. An additional 415 individuals who reported a previous diagnosis of hypertension had this diagnosis confirmed. Among individuals with a confirmed hypertension diagnosis (regardless of whether or not the diagnosis predated contact with the HealthRise program) for whom blood pressure readings were available, 191 patients had controlled blood pressure levels (SBP < 140 mmHg and DBP < 90 mmHg) at the time of the most recent available blood pressure measurement (Figure 7).

839 individuals who reported no previous diagnosis of diabetes were identified through the screening process as having elevated levels of blood sugar and were referred to a health facility for confirmatory diagnosis; 107 individuals who reported no previous diagnosis of diabetes received a confirmatory diagnosis of diabetes. An additional 172 individuals who reported a previous diagnosis of diabetes had this diagnosis confirmed. Among individuals with a confirmed diabetes diagnosis (regardless of whether or not the diagnosis predated contact with the HealthRise program) for whom blood glucose measurements were available, 94 patients had controlled blood glucose levels (A1c < 8%; FPG < 157; RBS < 183) at the time of their most recent available blood glucose measurement (Figure 7).

Females outnumbered males in all categories from “Newly Screened” to “Controlled” for both hypertension and diabetes. More detailed disaggregation can be found in Appendix D.

CHAI trained 1,060 health workers including 543 CHWs, who were trained to screen, counsel, follow up, and refer patients with diabetes or hypertension to health facilities. These community health workers played an instrumental role in executing the 258 patient support group and NCD club meetings that were organized by CHAI, which were attended by a cumulative 3,487 patients.

Shimla

MAMTA used 87,151 mixed communications activities – including street plays performed, radio shows aired, and pamphlets distributed – to increase awareness of hypertension and diabetes and to mobilize community members to attend HealthRise screening camps.

In an attempt to identify individuals at risk, MAMTA organized 336 screening events which were open to both those aware and not aware of their condition. A total of 22,053 individuals were screened; the cascade of care below describes the proportion of new patients.

Figure 8. Shimlacascade of care

Limiting to individuals who reported no previous diagnosis of hypertension, 20,606 individuals were screened for elevated blood pressure; 2,214 individuals were referred to health facilities based on elevated blood pressure at the time of the screening; and 555 individuals received a confirmatory diagnosis of hypertension. An additional 1,447 patients who reported a previous diagnosis of hypertension had this diagnosis confirmed. Among individuals with a confirmed diagnosis of hypertension (regardless of whether or not that diagnosis predated contact with the HealthRise program) for whom blood pressure readings were available, 330 individuals had controlled blood pressure levels (SBP < 140 mmHg and DBP < 90 mmHg) at the time of the most recent available blood pressure measurement (Figure 8).

Limiting to individuals who reported no previous diagnosis of diabetes, 21,482 individuals were screened for elevated blood glucose; 900 individuals were referred to health facilities based on elevated blood glucose at the time of the screening; and 56 individuals received a confirmatory diagnosis of diabetes. An additional 571 patients who reported a previous diagnosis of diabetes had this diagnosis confirmed. Among individuals with a confirmed diagnosis of diabetes (regardless of whether or not that diagnosis predated contact with the HealthRise program) for whom blood glucose readings were available, 253 individuals had controlled blood glucose levels (A1c < 8%; FPG < 157; RBS < 183) at the time of the most recent available blood glucose measurement (Figure 8).