title: Improved retention rates with low-cost interventions in hypertension and diabetes management in a rural African environment of nurse-led care: a cluster-randomised trial.
abstract: OBJECTIVE
  To compare the effects of low-level facility-based interventions on patient retention rates for cardiovascular (CV) disease in an environment of task shifting and nurse-led care in rural health districts in Central Cameroon.
  
  
  METHODS
  This study is an open-label, three-arm, cluster-randomised trial in nurse-led facilities. All three groups implemented a treatment contract. The control group (group 1) had no additional intervention, group 2 received the incentive of 1 month of free treatment every forth month of regularly respected visits, and group 3 received reminder letters in case of a missed follow-up visit. The primary outcome was patient retention at 1 year. Secondary outcomes were adherence to follow-up visit schemes and changes in blood pressure (BP) and blood glucose levels. Patients' monthly spending for drugs and transport was calculated retrospectively.
  
  
  RESULTS
  A total of 33 centres and 221 patients were included. After 1 year, 109 patients (49.3%) remained in the programme. Retention rates in groups 2 and 3 were 60% and 65%, respectively, against 29% in the control group. The differences between the intervention groups and the control group were significant (P < 0.001), but differences between the two intervention groups were not (P = 0.719). There were no significant differences in BP or fasting plasma glucose trends between retained patients in the study groups. Average monthly cost to patients for antihypertensive medication was € 1.1 ± 0.9 and for diabetics €1.2 ± 1.1. Transport costs to the centres were on average €1.1 ± 1.0 for hypertensive patients and €1.1 ± 1.6 for patients with diabetes.
  
  
  CONCLUSIONS
  Low-cost interventions suited to an environment of task shifting and nurse-led care and needing minimal additional resources can significantly improve retention rates in CV disease management in rural Africa. The combination of a treatment contract and reminder letters in case of missed appointments was an effective measure to retain patients in care.
authors: Swiss Tropical and Public Health Institute, Basel, Switzerland. niklaus.labhardt@gmail.com
authors: Niklaus D
authors: ND
authors: Labhardt
authors: Jean-Richard
authors: JR
authors: Balo
authors: Mama
authors: M
authors: Ndam
authors: Engelbert
authors: E
authors: Manga
authors: Beat
authors: B
authors: Stoll
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002163:Cameroon / Q000453:epidemiology; D003376:Counseling; D003920:Diabetes Mellitus / Q000191:economics* / Q000451:nursing*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000451:nursing*; D007318:Inservice Training; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D015397:Program Evaluation; D016016:Proportional Hazards Models; D017010:Reminder Systems; D012107:Research Design; D012424:Rural Population / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose