Evaluating a service model for management of hypertension and diabetes among low- and middle income patients enrolled on M-TIBA in Nairobi, Kenya, Ngao Ya Afya

Both hypertension (HTN) and diabetes represent two major risk factors for
atherosclerotic cardiovascular diseases (CVD), the number one cause of death globally1
. Despite the
clear evidence that lowering blood pressure (BP) and blood sugar through lifestyle changes and drug
treatment can greatly reduce the risk of CVD), HTN-control (defined as the proportion of people who
reach their target for BP lowering) and diabetes control (defined as HbA1c<7%) is still poor.
Objective: aim to develop, implement and evaluate a model that improves BP and blood sugar control
for patients and streamlines and partly finances the provision of hypertension and diabetes care for
healthcare providers while potentially reducing cost and improving access to quality care
Methodology: The core of the model is the interaction between M-TIBA (a mobile health platform for
financial inclusion in healthcare that enables people to save, send, receive and pay money for medical
treatment through a mobile health wallet on their phone) and mobile phone application (Afya-pap)
for patients and a patient tracker for healthcare providers, which will improve access and allow for
home-based measuring and monitoring of BP and blood sugar in both low and middle socio economic
status populations in Nairobi, Kenya. The project will test the acceptability of the mobile application
and feasibility of integrating the mHealth model into clinical care, including the effectiveness in
controlling BP and blood sugar respectively when patients receive regular text messages encouraging
them to take measurments at home or using a mini-tracker calendar. For the text messaging
behavioural intervention patients will be randomized to reminders on blood pressure measurements
in three arms (daily, weekly and no messages), and two arms for blood sugar measurments (weekly
and no messages). Three surveys (baseline, midline and endline-6 months apart) will be conducted to
estimate the proportion of patients with blood pressure and blood sugar controlled. The mini-tracker
behavioural intervention will be conducted among patients and evaluated through one-group prepost design. Cost-effectiveness of the intervention will also be evaluated.
Duration and budget: The project will be undertaken for 2 years. Interviews will be conducted with
healthcare providers and the patients. The total budget will be 151,688 USD
Conclusion: The outcomes of this project will inform the integration of the mHealth based service
model into the daily routine of the participating clinics. This generation of real-time clinical data, will
ensure easy translation into clinical practice, and will facilitate rapid scale-up.