A village health worker intervention to reduce cardiovascular disease risk in remote areas of armed conflict in Myanmar-results from a feasibility study in three villages.

Abstract

Background: Cardiovascular disease (CVD) is a leading cause of death in low-income countries and those affected by armed conflict, including Myanmar. Community health worker interventions can effectively address CVD risk factors in low-income countries but have not been tested among displaced populations in active conflict zones.

Objectives: We conducted a feasibility study of a village health worker (VHW) care model to identify individuals at high CVD risk and deliver care in conflict-affected regions of Karen State, Myanmar. This study was conducted by an international non-governmental organization collaborating with a regional local health organization.

Methods: Following a village census, trained VHWs and medics screened individuals age ≥ 40 for CVD risk factors in three villages. Eligible individuals had HTN, diabetes, calculated CVD risk > 10%, or history of heart attack or stroke, confirmed during a second visit 1-2 weeks later. VHWs visited households every 3-6 weeks for 2 months to monitor blood pressure, glucose, medication adherence/side effects, and deliver medic-prescribed medications. Feasibility evaluation centered on reach, adoption, and acceptability. Outcomes included CVD risk factor prevalence, recruitment and retention, medication initiation/adherence, changes in hypertension control, and adverse outcomes. VHW and medic focus group discussions and study participant interviews were conducted.

Results: CVD teams screened 294 individuals, conducted confirmatory visits with 132, enrolled all 97 eligible participants, and completed two home visits with 94 patients. Several prescription errors were made, halting medication initiation; root cause analysis identified opportunities to improve pre-testing of electronic tools and strengthen clinician CVD training. The proportion of eligible participants receiving antihypertensive or statin medications increased from 23% to 56%. Among those with HTN, the proportion achieving blood pressure control < 140/90 mmHg increased from 22.9% to 65.7%. Qualitative assessment revealed support for the care model and opportunities to improve training and streamline clinical protocols.

Conclusions: Our study suggests a VHW care model for CVD in remote villages in Myanmar experiencing armed conflict is feasible and can increase medication access. Opportunities exist to simplify CVD treatment guidelines and augment training and support of local providers. Findings informed a cluster randomized controlled trial to test the impact of a modified VHW care model on medication adherence, CVD risk, and cost.

Trial registration: ClinicalTrials.gov, NCT06819839, retrospectively registered 27 October 2024.