- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05743387
Community-based, eHealth Supported Type 2 Diabetes Care by Lay Village Health Workers in Rural Lesotho (ComBaCaL T2D)
Community-based, eHealth Supported Type 2 Diabetes Care by Lay Village Health Workers in Rural Lesotho Protocol for a Cluster-randomized Trial Within the ComBaCaL Cohort Study (ComBaCaL T2D TwiC)
This cluster-randomized intervention is embedded in the ComBaCaL (Community-Based Chronic disease care Lesotho) cohort study (EKNZ ID AO_2022-00058, clinicaltrials.gov ID NCT05596773, Lesotho NH-REC ID 210-2022), a platform for the investigation of chronic diseases and their management in rural Lesotho that is maintained by local lay chronic care village health workers (CC-VHWs).
The overall objective of the ComBaCaL cohort study and nested TwiCs is to assess the impact of eHealthsupported, lay-led chronic disease control measures in rural Lesotho.
In this T2D TwiC, the effect, safety and feasibility of a community-based T2D care package (which includes the offer of first-line oral antidiabetic and lipid-lowering treatment for uncomplicated T2D by lay CC-VHWs in comparison to facility-based care after community-based screening and diagnosis) will be evaluated.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Globally, 9.3% of the adult population or 436 million individuals were estimated to be living with diabetes in 2019. Until 2045 this number is expected to increase by more than 50% to over 700 million. Four out of five people affected by diabetes are currently living in low- and middle-income countries (LMICs). Over 90% of all diabetes cases are due to type 2 diabetes (T2D) which is also the main driver of the projected increase in overall diabetes cases. The increase in T2D prevalence is caused by ageing populations and changing lifestyles with decreasing levels of physical activity and higher caloric diets and associated obesity.
This cluster-randomized intervention is embedded in the ComBaCaL (Community-Based Chronic disease care Lesotho) cohort study (EKNZ ID AO_2022-00058, clinicaltrials.gov ID NCT05596773, Lesotho NH-REC ID 210-2022), a platform for the investigation of chronic diseases and their management in rural Lesotho that is maintained by local lay chronic care village health workers (CC-VHWs).
In this trial, using the Trials within Cohorts (TwiCs) approach, it will be analyzed whether an LHW-led model could be capacitated to safely and effectively provide first-line management (including oral antidiabetic, lipid-lowering treatment and lifestyle counselling) at community-level.
In villages randomized to the intervention arm, lay Chronic Care Village Health Workers (CCVHWs) operating within the existing Ministry of Health (MoH) village health worker system will be capacitated to screen for and diagnose T2D, to provide lifestyle counselling, to prescribe and to monitor first-line antidiabetic and lipid-lowering treatment for uncomplicated T2D and to provide treatment support for complicated T2D, supported by a tailored clinical decision support application (ComBaCaL app) in their villages.
The control group consists of people diagnosed with T2D living in villages that are also part of the ComBaCaL cohort but not sampled for the intervention (control villages), where CC-VHWs will only screen for and diagnose T2D with subsequent standardized counselling and referral to the closest health facility if T2D is present, but no village-based prescriptions. The overall objective of the ComBaCaL cohort study and nested TwiCs is to assess the impact of eHealthsupported, lay-led chronic disease control measures in rural Lesotho.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Niklaus Labhardt, Prof.
- Phone Number: +41 79 870 18 59
- Email: niklaus.labhardt@usb.ch
Study Contact Backup
- Name: Alain Amstutz, Dr.
- Phone Number: +41 79 489 94 48
- Email: alain.amstutz@usb.ch
Study Locations
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Maseru, Lesotho
- Recruiting
- Solidarmed Lesotho
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Contact:
- Irene Ayakaka, MD
- Phone Number: +266 28325172
- Email: ayakaka@gmail.com
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Principal Investigator:
- Irene Ayakaka, MD
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Sub-Investigator:
- Mamakhala Chitja, MBBS
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Sub-Investigator:
- Ravi Gupta, MBBS
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Basel, Switzerland, 4051
- Recruiting
- University of Basel, Division of Clinical Epidemiology
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Contact:
- Niklaus Labhardt, Prof.
- Phone Number: +41 79 870 18 59
- Email: niklaus.labhardt@usb.ch
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Contact:
- Felix Gerber
- Phone Number: +41 78 704 08 85
- Email: felix.gerber@usb.ch
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Principal Investigator:
- Niklaus Labhardt, Prof.
-
Principal Investigator:
- Alain Amstutz, MD
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Sub-Investigator:
- Felix Gerber
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Sub-Investigator:
- Thabo Lejone
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Participant of the ComBaCaL cohort study (signed informed consent available)
- Living with T2D, defined as reporting intake of antidiabetic medication or being newly diagnosed during screening via standard diagnostic algorithm
Exclusion Criteria:
- Known type 1 diabetes mellitus
- Reported pregnancy
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Intervention villages
In the intervention villages, CC-VHWs will offer
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T2D care package including lifestyle counselling, firstline antidiabetic (metformin) and lipid-lowering (statin) treatment for uncomplicated T2D and treatment support and regular check-ups for complicated T2D at village-level.
Guidance will be provided via the ComBaCaL app.
In case of complicated disease referral to the closest health facility for further management.
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Active Comparator: Control villages
In control villages, CC-VHWs will refer participants to the responsible health facility for therapeutic management after enrolment and baseline assessment.
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CC-VHWs will refer participants to the responsible health facility for therapeutic management.
The ComBaCaL app supports clinical decision making and documentation for screening, diagnosis and referral, but not prescription/provision and monitoring of antidiabetic or lipid-lowering medication for uncomplicated T2D patients or treatment support for complicated T2D patients.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mean HbA1c (in percent)
Time Frame: 12 months after enrolment
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Mean HbA1c (in percent)
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12 months after enrolment
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in 10-year CVD risk estimated
Time Frame: 6 and 12 months after enrolment
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Change in 10-year CVD risk estimated using the World Health Organization (WHO) CVD risk prediction tool
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6 and 12 months after enrolment
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Mean HbA1c (in percent)
Time Frame: 6 months after enrolment
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Mean HbA1c (in percent)
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6 months after enrolment
|
Change in mean fasting blood glucose (FBG) (mmol/l)
Time Frame: 6 and 12 months after enrolment
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Change in mean fasting blood glucose (FBG) (mmol/l)
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6 and 12 months after enrolment
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Change in proportion of participants with an HbA1c below 8%
Time Frame: 6 and 12 months after enrolment
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Change in proportion of participants with an HbA1c below 8%
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6 and 12 months after enrolment
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Change in proportion of participants with an FBG below 7 mmol/l
Time Frame: 6 and 12 months after enrolment
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Change in proportion of participants with an FBG below 7 mmol/l
|
6 and 12 months after enrolment
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Change in number of CVD risk factors
Time Frame: 6 and 12 months after enrolment
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Change in number of CVD risk factors (such as smoking status, BMI, abdominal circumference, blood lipid status, blood pressure, dietary habits and physical activity)
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6 and 12 months after enrolment
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Linkage to care: Change in proportion of participants not taking treatment at enrolment who have initiated pharmacological antidiabetic treatment
Time Frame: 6 and 12 months after enrolment
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Change in proportion of participants not taking treatment at enrolment who have initiated pharmacological antidiabetic treatment
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6 and 12 months after enrolment
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Engagement in care: Change in proportion of participants who are engaged in care
Time Frame: 6 and 12 months after enrolment
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Change in proportion of participants who are engaged in care, defined as reporting intake of antidiabetic medication as per prescription of a healthcare provider or reaching treatment targets without intake of medication
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6 and 12 months after enrolment
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Change in self-reported adherence to antidiabetic medication
Time Frame: 6 and 12 months after enrolment
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Change in self-reported adherence to antidiabetic medication
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6 and 12 months after enrolment
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Occurrence of Serious Adverse Events (SAEs) and Adverse Events of Special Interest (AESIs)
Time Frame: within 6 and 12 months after enrolment
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Occurrence of Serious Adverse Events (SAEs) and Adverse Events of Special Interest (AESIs)
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within 6 and 12 months after enrolment
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of consultations (at a health facility and with the CC-VHW)
Time Frame: within 6 and 12 months after enrolment
|
Number of consultations at a health facility and with the CC-VHW
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within 6 and 12 months after enrolment
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Trajectory of participants between facility-based and community-based care in the intervention villages
Time Frame: during the study period (up to 12 months)
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Trajectory of participants between facility-based and community-based care in the intervention villages (i.e.
number of participants accepting community-based care at baseline, number of people switching to facility-based care and back to community-based care
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during the study period (up to 12 months)
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Proportion of participants with T2D who stop drug treatment or interrupt drug treatment for more than three weeks or require a switch of drug treatment due to (perceived) adverse events (AEs)
Time Frame: within 6 and 12 months after enrolment
|
Proportion of participants with T2D who stop drug treatment or interrupt drug treatment for more than three weeks or require a switch of drug treatment due to (perceived) adverse events (AEs)
|
within 6 and 12 months after enrolment
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Change in proportion of participants who are reaching treatment targets (FBG <7 mmol/l) and are reporting no intake of antidiabetic medication in the two weeks prior to assessment
Time Frame: 6 and 12 months after enrolment
|
Change in proportion of participants who are reaching treatment targets (FBG <7 mmol/l) and are reporting no intake of antidiabetic medication in the two weeks prior to assessment
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6 and 12 months after enrolment
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Change in proportion of participants accessing lipid-lowering medication
Time Frame: 6 and 12 months after enrolment
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Change in proportion of participants accessing lipid-lowering medication
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6 and 12 months after enrolment
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Change in health system costs for the management of participants condition
Time Frame: within 6 and 12 months after diagnosis
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Change in health system costs for the management of participants condition
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within 6 and 12 months after diagnosis
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Change in individual costs for participants for the management of their condition
Time Frame: within 6 and 12 months after diagnosis
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Change in individual costs for participants for the management of their condition
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within 6 and 12 months after diagnosis
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Change in10-year CVD risk estimated using the Globorisk score
Time Frame: 6 and 12 months after enrolment
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Change in10-year CVD risk estimated using the Globorisk score, a cardiovascular disease risk score that predicts risk of heart attack or stroke in healthy individuals for all countries in the world.
It uses information on a person's country of residence, age, sex, smoking, diabetes, blood pressure and cholesterol to predict the chance that they would have a heart attack or stroke in the next 10 years.
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6 and 12 months after enrolment
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Change in10-year CVD risk estimated using the Framingham Risk Score
Time Frame: 6 and 12 months after enrolment
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Change in10-year CVD risk estimated using the Framingham Risk Score, a sex-specific algorithm used to estimate the 10-year cardiovascular risk of an individual.
The Framingham Risk Score was first developed based on data obtained from the Framingham Heart Study.
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6 and 12 months after enrolment
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Quality of life (QOL) using the EQ-5D-5L instrument
Time Frame: 12 months after enrolment
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The EQ-5D-5L is a self-assessed, health related, quality of life questionnaire.
The scale measures quality of life on a 5-component scale including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.
The QOL scores are summed so that a higher score indicates higher quality of life.
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12 months after enrolment
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Health beliefs using the Beliefs about Medicines Questionnaire (BMQ) adapted for people living with T2D
Time Frame: 12 months after enrolment
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The BMQl comprises two 4-item factors assessing beliefs that medicines are harmful, addictive, poisons which should not be taken continuously and that medicines are overused by doctors.The items are scored on a 5 point Likert scale with scores ranging from 4 to 20.
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12 months after enrolment
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Diabetes distress using the five item version of the "Problem Areas in Diabetes" (PAID-5) scale Problem Areas in Diabetes Scale-Five-item Short Form
Time Frame: 12 months after enrolment
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Problem Areas in Diabetes Scale-Five-item Short Form.
Total scores on the PAID-5 can range from 0 to 20, with higher scores suggesting greater diabetes-related emotional distress.
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12 months after enrolment
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Change in dosage of antidiabetic medications prescribed by CC-VHWs or healthcare professionals
Time Frame: 6 and 12 months after enrolment
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Change in dosage of antidiabetic medications prescribed by CC-VHWs or healthcare professionals
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6 and 12 months after enrolment
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Change in dosage of lipid-lowering medications prescribed by CC-VHWs or healthcare professionals
Time Frame: 6 and 12 months after enrolment
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Change in dosage of lipid-lowering medications prescribed by CC-VHWs or healthcare professionals
|
6 and 12 months after enrolment
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Niklaus Labhardt, Prof., Division of Clinical Epidemiology, University Hospital Basel
- Principal Investigator: Alain Amstutz, MD, Division of Clinical Epidemiology, University Hospital Basel, University of Basel
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
- low- and middle-income countries (LMICs)
- Community-Based Chronic Disease Care Lesotho (ComBaCaL) cohort study
- Lesotho Ministry of Health (MoH) Village Health Worker Program
- glycated haemoglobin (HbA1c)
- lay healthcare worker (LHW)
- chronic care village health worker (CC-VHW)
- chronic care nurse (CC nurse)
- non-communicable disease (NCD)
- blood glucose (BG)
- cardiovascular disease risk factor (CVDRF)
- first-line antidiabetics
- first-line lipid-lowering treatment
Additional Relevant MeSH Terms
Other Study ID Numbers
- AO_2022-00077; am23Labhardt
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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