Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study.
Background
Non-communicable diseases (NCDs) contribute greatly to morbidity and mortality in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, but data are lacking. We assessed the impact of a CHW-led intervention on disease control and adherence among patients with diabetes and/or hypertension in Chiapas, Mexico.


Methods
We conducted a prospective observational study among adult patients with diabetes and/or hypertension, in the context of a stepped-wedge roll-out of a CHW-led intervention. We measured self-reported adherence to medications, blood pressure and haemoglobin A1c at baseline and every 3 months, timed just prior to expansion of the intervention to a new community. We conducted individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community.


Findings
We analysed 108 patients. The CHW-led intervention was associated with a twofold increase in the odds of disease control (OR 2.04, 95% CI 1.15 to 3.62). It was also associated with optimal adherence assessed by 30-day recall (OR 1.86; 95% CI 1.15 to 3.02) and a positive self-assessment of adherence behaviour (OR 2.29; 95% CI 1.26 to 4.15), but not by 5-day recall.


Interpretation
A CHW-led adherence intervention was associated with disease control and adherence among adults with diabetes and/or hypertension. This study supports a role of CHWs in supplementing comprehensive primary care for patients with NCDs in LMICs.


Trial registration number
NCT02549495.
['Newman|Patrick M|PM|0000-0002-3061-9651', 'Franke|Molly F|MF|', 'Arrieta|Jafet|J|', 'Carrasco|Hector|H|', 'Elliott|Patrick|P|', 'Flores|Hugo|H|', 'Friedman|Alexandra|A|', 'Graham|Sophia|S|', 'Martinez|Luis|L|', 'Palazuelos|Lindsay|L|', 'Savage|Kevin|K|', 'Tymeson|Hayley|H|', 'Palazuelos|Daniel|D|']
diabetes hypertension health systems evaluation