“Through the preliminary collection of data on the barriers to effective care delivery through the EMR, it is anticipated that many of the innovative programs developed to support the provision of comprehensive HIV care will be able to directly address many of the challenges to the delivery of diabetes care. This includes the provision of nutrition support, home-based screening and care, income generating opportunities, gestational diabetes screening and care, and research to identify the unique features of diabetes in sub-Saharan Africans and best approaches for management.”
Background: The initial focused effort on addressing the HIV pandemic in sub-Saharan Africa has helped set the groundwork for addressing many of the other areas of the health-care system requiring support in resource-constrained settings. With the growing prevalence of diabetes in this setting, the US Agency for International Development-Academic Model Providing Access to Healthcare Partnership (USAID-AMPATH) has begun developing infrastructure to meet the growing need for diabetes care.
Objective: To describe the evolution of diabetes care in the rural, resource-constrained setting of western Kenya and to analyze preliminary data on the current status of glucose control of patients.
Methods: Through partnerships, USAID-AMPATH has facilitated the provision of basic modalities of diabetes care, including reliable stocks of insulin, hemoglobin A(1c) (A1C) testing, and point-of-care glucose-testing supplies.
Results: Through the introduction of A1C testing, the poor quality of diabetes care was revealed, as the average A1C for the clinic population was 10.4%, with insulin-dependent patients constituting the majority of individuals with markedly elevated A1C levels. To address this, a contextualized electronic medical record and a cell phone-based home glucose monitoring program were created to improve glycemic control, which has led to significant reductions in A1C levels.