Chronic Obstructive Pulmonary Disease Self-Management in Three LMICs: A Pilot Randomized Trial.

Siddharthan, Trishul; Ricciardi, Federico; Kirenga, Bruce; Miranda, J. Jaime; Mohan, Sakshi; Grunstra, Kelli; Shrestha, Laxman; Soares, Marta O.; Quaderi, Shumonta; Rykiel, Natalie A.; Sharma, Arun K.; Hossen, Shakir; Chandyo, Ram; Alupo, Patricia; Kumar Das, Santa; Ascencio, Ivonne; Flores-Flores, Oscar; Hurst, John R.; Gianella Malca, Gonzalo Ernesto; Checkley, William; Wosu, Adaeze C.; Pollard, Suzanne L.; Barber, Julie A.

dc.contributor.author	Pollard, Suzanne L.
dc.contributor.author	Siddharthan, Trishul
dc.contributor.author	Hossen, Shakir
dc.contributor.author	Rykiel, Natalie A.
dc.contributor.author	Flores-Flores, Oscar
dc.contributor.author	Alupo, Patricia
dc.contributor.author	Quaderi, Shumonta
dc.contributor.author	Ascencio, Ivonne
dc.contributor.author	Barber, Julie A.
dc.contributor.author	Chandyo, Ram
dc.contributor.author	Kumar Das, Santa
dc.contributor.author	Gianella Malca, Gonzalo Ernesto
dc.contributor.author	Kirenga, Bruce
dc.contributor.author	Grunstra, Kelli
dc.contributor.author	Miranda, J. Jaime
dc.contributor.author	Mohan, Sakshi
dc.contributor.author	Ricciardi, Federico
dc.contributor.author	Sharma, Arun K.
dc.contributor.author	Shrestha, Laxman
dc.contributor.author	Soares, Marta O.
dc.contributor.author	Wosu, Adaeze C.
dc.contributor.author	Hurst, John R.
dc.contributor.author	Checkley, William
dc.date.accessioned	2023-10-09T17:09:16Z
dc.date.available	2023-10-09T17:09:16Z
dc.date.issued	2023
dc.identifier.uri	https://hdl.handle.net/20.500.12866/14209
dc.description.abstract	INTRODUCTION: Chronic obstructive pulmonary disease (COPD) disproportionately affects low- and middle-income countries (LMICs). Health systems are ill-prepared to manage the increase in COPD cases. METHODS: We carried out a pilot effectiveness-implementation randomized field trial of a community health worker (CHW)-supported, one-year self-management intervention in individuals with COPD grade B-D. The study took place in low-resource settings of Nepal, Peru, and Uganda. The primary outcome was the St. George's Respiratory Questionnaire (SGRQ) score at one year. We evaluated differences in moderate-to-severe exacerbations, all-cause hospitalizations and the EuroQol score (EQ5D-3L) at 12 months. RESULTS: We randomly assigned 239 participants (119 control, 120 intervention) with grade B-D COPD to a multi-component, CHW-supported intervention or standard of care and COPD education. 25 participants (21%) died or were lost to follow-up in the control arm compared to 11 (9%) in the intervention arm. At 12 months, there was no difference in mean total SGRQ scores between intervention and control arms (34.7 vs. 34.0 points; adjusted mean difference 1.0, 95% CI -4.2 to 6.1; p=0.71). The intervention arm had a higher proportion of hospitalizations (10% vs 5.2%; adjusted odds ratio 2.2, 95% CI 0.8-7.5; p=0.15) at 12 months compared to controls. CONCLUSION: A CHW-based intervention to support self-management of acute exacerbations of COPD in three resource-poor settings did not result in differences in SGRQ scores at one year. Fidelity was high, and intervention engagement was moderate. While results cannot differentiate between a failed intervention or implementation, it nonetheless suggests that we need to revisit our strategy.	en_US
dc.language.iso	eng
dc.publisher	American Thoracic Society
dc.relation.ispartofseries	American Journal of Respiratory and Critical Care Medicine
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	COPD	en_US
dc.subject	Self-management	en_US
dc.subject	Global Health	en_US
dc.subject	Community Health Workers	en_US
dc.title	Chronic Obstructive Pulmonary Disease Self-Management in Three LMICs: A Pilot Randomized Trial.	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1164/rccm.202303-0505OC
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.07
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.08
dc.relation.issn	1535-4970