Research

The Centre will address the most prevalent classes of NCDs within Latin America: Diabetes, Cardiovascular Diseases (CVD), Chronic Respiratory Diseases and Mental Disorders.

Preparatory work with stakeholders will be followed by pragmatic trials, blending effectiveness research with real-world implementation to maximise sustainability and impact. Broadly, the research conducted will focus on improving community treatment via resource-oriented interventions that influence health behaviours, reduce modifiable risk factors and shift attitudes.

Rather than aiming to establish new expensive services, these interventions are low-cost and utilise the existing personal and social resources available to patients, their families and within the wider community. We will focus on what can be changed and implemented within the community and on low-cost evidence-based interventions that can be applied alongside basic services.

Situation Analysis

This will include an exploratory Situation Analysis phase, to access resources and challenges on the pathways of care for each country.

Pilot

Followed by the conduction of pilots of low-resources interventions on three sites, such as 1) DIALOG+, an easy to train IT-supported method to improve the effectiveness of routine consultations; 2) multi-family groups; 3) peer support and 4) volunteer befriending by non- professionals with groups of patients. All of the approaches utilise and strengthen existing resources, including social networks and community support, and have the potential to reduce modifiable risk factors, including those common across different NCDs.

Stepped-Wedge Trials

As a final stage, we’ll test effectiveness of the interventions in two large-scale Hybrid II trials. One will focus on Diabetes, CVD, Chronic Respiratory Diseases as three highly comorbid conditions with some common and modifiable risk factors, with subgroups for each major included NCD. The other trial will address Mental Disorders with subgroups for major disorder categories. Hybrid II trials enable estimating effectiveness whilst ensuring the research remains pragmatic and addresses implementation in practice13. Both trials will be conducted in urban and rural regions, including areas with large indigenous populations.