title: Impact of Bridging Income Generation with Group Integrated Care (BIGPIC) on Hypertension and Diabetes in Rural Western Kenya.
abstract: BACKGROUND
  Rural settings in Sub-Saharan Africa (SSA) consistently report low participation in non-communicable disease (NCD) treatment programs and poor outcomes.
  
  
  OBJECTIVE
  The objective of this study is to assess the impact of the implementation of a patient-centered rural NCD care delivery model called Bridging Income Generation through grouP Integrated Care (BIGPIC).
  
  
  METHODS
  The study prospectively tracked participation and health outcomes for participants in a screening event and compared linkage frequencies to a historical comparison group.
  
  
  METHODS
  Rural Kenyan participants attending a voluntary NCD screening event were included within the BIGPIC model of care.
  
  
  METHODS
  The BIGPIC model utilizes a contextualized care delivery model designed to address the unique barriers faced in rural settings. This model emphasizes the following steps: (1) find patients in the community, (2) link to peer/microfinance groups, (3) integrate education, (4) treat in the community, (5) enhance economic sustainability and (6) generate demand for care through incentives.
  
  
  METHODS
  The primary outcome is the linkage frequency, which measures the percentage of patients who return for care after screening positive for either hypertension and/or diabetes. Secondary measures include retention frequencies defined as the percentage of patients remaining engaged in care throughout the 9-month follow-up period and changes in systolic (SBP) and diastolic blood pressure (DBP) and blood sugar over 12 months.
  
  
  RESULTS
  Of the 879 individuals who were screened, 14.2 % were confirmed to have hypertension, while only 1.4 % were confirmed to have diabetes. The implementation of a comprehensive microfinance-linked, community-based, group care model resulted in 72.4 % of screen-positive participants returning for subsequent care, of which 70.3 % remained in care through the 12 months of the evaluation period. Patients remaining in care demonstrated a statistically significant mean decline of 21 mmHg in SBP [95 % CI (13.9 to 28.4), P < 0.01] and 5 mmHg drop in DBP [95 % CI (1.4 to 7.6), P < 0.01].
  
  
  CONCLUSIONS
  The implementation of a contextualized care delivery model built around the unique needs of rural SSA participants led to statistically significant improvements in linkage to care and blood pressure reduction.
authors.affiliation: Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya. spastaki@purdue.edu.|Moi Teaching and Referral Hospital, Eldoret, Kenya. spastaki@purdue.edu.|College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya. spastaki@purdue.edu.|College of Pharmacy, Purdue University, West Lafayette, IN, USA. spastaki@purdue.edu.
authors.forename: Sonak D
authors.initials: SD
authors.lastname: Pastakia
authors.affiliation: Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.|Moi Teaching and Referral Hospital, Eldoret, Kenya.|College of Pharmacy, Purdue University, West Lafayette, IN, USA.
authors.forename: Simon M
authors.initials: SM
authors.lastname: Manyara
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Vedanthan
authors.affiliation: Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.|Moi Teaching and Referral Hospital, Eldoret, Kenya.|College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
authors.forename: Jemima H
authors.initials: JH
authors.lastname: Kamano
authors.affiliation: College of Health Sciences, School of Public Health, Moi University, Eldoret, Kenya.
authors.forename: Diana
authors.initials: D
authors.lastname: Menya
authors.affiliation: Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Andama
authors.affiliation: Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.
authors.forename: Cleophas
authors.initials: C
authors.lastname: Chesoli
authors.affiliation: Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.|College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.|Webuye District Hospital, Webuye, Kenya.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Laktabai
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D007182:Income / Q000639:trends*; D007630:Kenya; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012424:Rural Population / Q000639:trends*
keywords: agriculture; diabetes; hypertension; incentives; microfinance; portable care; rural; sub-Saharan Africa