Scaling Up NCD Interventions in South East Asia (SUNI-SEA)

University of Groningen, University of Passau, Universitas Sebelas Maret, Health Strategy and Policy Institute, Trnavska Universita v Trnava, HelpAge International, Thai Nguyễn University of Medicine and Pharmacy

The SUNI-SEA study is an intervention study that measures effectiveness and cost-effectiveness of prevention and early diagnosis of diabetes and cardiovascular diseases in communities and primary healthcare (PHC) facilities in Indonesia, Myanmar and Vietnam.

The study takes place in Vietnam and Indonesia in Intergenerational Self-Help Clubs (ISHGs), where community members assemble for activities concerning social, economical improvement and health and well-being. Volunteers in these ISHGs are trained in performing screening for diabetes and cardiovascular diseases and counselling participants concerning healthy living, or referral to primary healthcare facilities, if needed. At PHC level further diagnosis and if needed treatment is provided and referral back to ISHGs is done for lifestyle interventions. In Indonesia screening takes place in the Posbindu programme, where trained volunteers (cadres) screen and counsel participants. If needed referral to Puskesmas (primary healthcare facilities is done, where further diagnosis and treatment takes place. Activities for health promotion and lifestyle interventions take place under supervision of the Posbindu programme. In Myanmar and Indonesia individual monitoring and health education of participants is done through mobile applications. Measuring of uptake, follow-up and adherence to interventions is done through routine data collection, through surveys, and through semi-structured interviews and focus group discussions.

In Vietnam members from 150 Intergenerational Self Help Clubs are invited to undergo screening for diabetes and cardiovascular diseases. (total number of persons between 7,500 and 15,000 persons) In Myanmar members from 150 Intergenerational Solidarity Groups are invited to undergo screening for diabetes and cardiovascular diseases. (total number of persons between 7,500 and 15,000 persons) In Indonesia, visitors of 20 Posbindu programmes are offered screened for diabetes and hypertension in Central and East Java (between 10,000 and 20,000 persons)

Screening for NCDs based on questionnaire concerning vital information, lifestyle, simple measures of length, bodyweight, BMI, blood pressure, application of FinRisk score and WHO risk score. Health promotion and lifestyle counselling and referral to PHC facilities for further diagnosis and treatment.

lifestyle coaching for persons with risk factors for NCDs, referral to primary healthcare facilities for further diagnosis and treatment, simple treatment of NCDs at primary healthcare level, Online monitoring and counselling for risk factors for NCDs

Screening in Intergenerational solidarity clubs in Myanmar and Vietnam and in Posbindu programme in Indonesia

Percentage of participants in screening who follow up on recommendations given during screening (referral, lifestyle change)

12 months from counselling and advice to individual until measuring adherence to follow-up that has been recommended

Percentage of adults above 21 years in communities participating in one or more health education sessions offered

Unit costs of screening, prevention and early diagnosis of NCDs per Quality Adjusted Life Year gained

Unit costs of NCD screening, prevention, early diagnosis intervention per Quality Adjusted Life Year gained

18 months between starting calculation of costs of interventions and assessment of final assessment of benefits

Comparison of costs and effects between intervention and business as usual, using diff in diff method

Impact of training of community health volunteers in NCD interventions on knowledge attitudes and practices of volunteers

Difference in knowledge, attitudes and practices (KAP) of volunteers in ISHCs in Myanmar and Vietnam, and cadres in Posbindu in Indonesia as result of training offered in the research project, measured by pre- and post-training KAP survey and six months after training.

6 months between provision of training to community health volunteers and measuring their skills, knowledge and attitudes

Performance of community health volunteers six months after training, measured by observational study, with measuring adherence to standard operating procedures for screening for NCDs and health education.

6 months between provision of training to community health volunteers and measuring their performance

Inclusion Criteria: All adults living in geographical area where research takes place Exclusion Criteria: Persons who are not able to come to location of screening, due to illness or other chronic condition causing immobility.

Following open research guidelines of European Union data will be shared about screening, follow-up and referral. Data collected in cos-effectiveness analysis will be shared

Data will become available after July 2023 and will be available for period according to regulations of European Union