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How to Improve Retention Rates in NCCD Programmes in Rural Africa: The TAHADIRA Trial

Author(s): N. D. Labhardt*1, J. Balo2, E. Manga3, M. Ndam4, B. Stoll5
Affiliation(s): 1Swiss Tropical Institute, University of Basel, Basel, Switzerland, 2District Hospital Mfou, Ministry of Public Health of Cameroon, Mbankomo, 3Ministry of Public Health, 4District Hospital Mfou, Ministry of Public Health of Cameroon, Mfou, Cameroon, 5Institute of Social and Preventive Medicine, Faculty of Medicine, Geneva, Switzerland
Keywords: Hypertension, diabetes, treatment adherence, treatment retention, non-communicable chronic diseases
Background:

Low retention rates and poor treatment adherence pose major challenges to programs for non-communicable chronic diseases (NCCD) in Africa. Monitoring data of a program that integrated management of arterial hypertension and diabetes into the primary health care of non-physician clinics (NPCs) in eight rural Cameroon districts reveal a one-year retention-rate below 50%. In order to improve the effectiveness of large NCCD-programs, efficient and easily replicable interventions to improve treatment adherence are urgently needed. The aim of this randomized trial is to compare two low-cost interventions on a NPC level in rural Cameroon to lower the attrition in the program.

Methods:

Thirty three rural NPCs from four districts were randomly assigned into three groups: The control group requested a written and oral commitment from the patient to follow the treatment before the treatment start. Facilities of the intervention group A had additionally an active patient-tracing by community representatives. Intervention group B provided as an incentive for adherence one month of treatment for free every four completed months with good adherence.
At one patient-year we assess as the primary outcome the percentage of patients with a regular follow-up. Secondary outcome measures are: percentage of missed follow-up visits (i) trend in blood pressure among hypertensive patients (ii) and trend in fasting plasma glucose in diabetic patients (iii). The study is registered at www.clinicaltrials.gov (NCT00744458)

Results/Conclusions:

During a period of six months, the 33 NPC-clinics recruited 218 new, treatment-naïve patients. The average age was 60 years (inter quartile range: 51-68), 65% were female. Sixty eight percent had arterial hypertension alone, 18% arterial hypertension and impaired fasting glucose, 11% hypertension and diabetes and 9% diabetes alone.
In February 2010 the study will be closed and data collection performed. The primary and secondary outcome measures of this study will be presented at the Geneva Health Forum 2010. This will contribute to the discussion on how to improve the retention rate in NCCD programs in general and give specifically information on the evolution of hypertensive and diabetic patients who are followed by general NPCs in a rural primary health care setting in Cameroon.

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