Implementation of a community-led strategy to reduce cardiovascular disease risk among conflict-affected populations in eastern Myanmar

Purpose

This study aims to:

• Develop, utilising causal loop analysis (CLA), a service delivery model that integrates village health workers (VHWs) into local health organisation strategies to improve cardiovascular disease (CVD) prevention.
• Examine the feasibility and acceptability of the model utilising the Consolidated Framework for Implementation Research (CFIR).
• Conduct a cluster randomised controlled trial (cRCT) at the village level to estimate the causal relationship of the VHW model on the proportion of adults over 40 years old taking appropriate CVD medications. Secondary outcomes include estimated change in 10-year CVD risk, community screened, linkage to care, 30day adherence to medication, changes in blood pressure (BP) and blood glucose (BG), and cost.
• Conduct a cost-effectiveness analysis (CEA) and distributional CEA of the intervention.

Expected Outcomes

Control of CVD risk factors requires consistent, longitudinal access to medications. Most CVD care models are based on professional clinicians and health facilities. However, given the prolonged nature of conflict, this is simply not possible in many regions — and many of these regions have a high burden of CVD prior to conflict.  It is hoped that the research will identify key best practices in creating a locally led VHW programme focusing on mitigating CVD risk in eastern Myanmar, a region affected by prolonged conflict. The study envisages to develop an approach that might be replicated in other regions, including an explicit approach involving affected communities and regional health leadership (in this case, leadership of local health organisations), in order to develop a locally relevant programme.