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Scaling-up Packages of Interventions for Cardiovascular disease prevention in selected sites in Europe and Sub-Saharan Africa: An implementation research (SPICES Project)

Periodic Reporting for period 3 - SPICES (Scaling-up Packages of Interventions for Cardiovascular disease prevention in selected sites in Europe and Sub-Saharan Africa: An implementation research (SPICES Project))

Reporting period: 2020-01-01 to 2021-06-30

By the year 2030, non-communicable diseases will account for more than three-quarters of deaths worldwide. In Europe, cardiovascular diseases (CVDs) will be the leading causes of death. The burden of CVD is highest among individuals in the lower socio-economic quintiles. In low- and middle-income countries (LMIC) where CVDs will be responsible for more deaths than infectious diseases, maternal and perinatal conditions, and nutritional disorders combined. Several interventions with scale-up potential can strengthen health systems to provide care for CVD. However, implementation to scale remains limited. Therefor the overall objective of the SPICES project is to implement and evaluate a comprehensive CVD prevention and care program at the community level in five countries (Belgium, France, Uganda, UK, South Africa), to identify and compare barriers and facilitators for implementation across study contexts and to develop a learning community. The project focusses on four (4) groups of interventions: Health promotion; cardiovascular risk profiling; Management and Self-management & follow-up.
During the period M19-M36, all teams developed their contextual intervention and evaluation plan based on the general intervention and evaluation plans submitted during the first reporting period. Contextual protocols were submitted and approved by local ethics comities and were registered in WHO-or ICMJE-approved registers. All partners started to implement the profiling of members of the communities and began coaching people with increased risk for cardiovascular diseases. So, the focus of this current report will be on the implementation of the interventions in the different settings, including the training, the development of material and the evaluation. Partners also continued their interaction with stakeholders and increased their networking activities and started dissemination of first results. During the face-to-face and skype meetings, the teams shared findings and discuss experiences and started comparison between sites of the implementation of CVD prevention and control activities.

The coordinator and project manager (WP 1), in collaboration with the Consortium members, organised three face-to-face meetings in different locations (Antwerp, Limpopo, Sussex). Every meeting included a workshop (GDPR, Scientific writing) or a community activity (Official ceremony for home based cares to receive certificate of CVD prevention training at UL). The tradition of field visits was continued for those settings we did not visit during the last reporting period (UA and UL). The Consortium partners continued their efforts for mutual learning (learning community) during the face to face and work meetings by skype.

Several efforts have been undertaken to disseminate SPICES work (WP 8) both locally, at the contextual level and internationally at the Global level. During this period, at least each site has presented an abstract on SPICES work at a research or scientific conferences either as poster or oral presentation. The project website continued to be updated with project activities. A third edition of SPICES Newsletter was published. Different contexts were hosted on local media, designed local websites and social media sites. A global SPICES twitter handle was created. Scientific protocols and articles have been published and contextual protocols were registered with accredited national or international registries.

A summary of activities of the implementation activities is provided in the next paragraphs. Details are reported in the different work package reports.
WP 2 ended in this reporting period. The main objective was to provide crucial information and a realistic picture of the opportunities, resources, challenges and barriers in relation to CVD prevention and management in the project sites. Situational analysis, development of local project plans, designing and testing the RedCAP tool for data collection, developing and implementing training for profilers and coaches and baseline surveys have been done. D2.2 (mHealth evaluation report) was submitted and milestones 4, 5 and 6 were met during this reporting period. Involvement with stakeholders, looking into barriers and facilitators, training profilers and coaches will continue and will be reported in the implementation and evaluation packages (WP 4-5-6-7).

Teams started to implement their health promotion activities (WP 3) through community engagement and knowledge translation approaches (based on D3.1). NTU, in collaboration with the consortium, developed a model to consider case studies for the SPICES Project at micro level (within the setting), meso-level (at partner level) and macro level (at whole consortium / global level). This model was agreed by consortium members and work is beginning to define a set of agreed criteria to enable cross and meta-analysis of the cases.

Within the Consortium, early on the decision was made to focus on primary prevention of CVD and to concentrate mainly on non-medical (lifestyle) interventions, leading to 2 big foci in all settings: First, profiling participants for their cardiovascular disease risk, mostly by non-medically trained community members (mainly reported in WP 4) and second, supporting/coaching those who have an intermediated risk in changing their lifestyle while referring those with a high risk to usual care (mainly reported in WP 5 and 6). A basic guide for these training profilers and coaches was developed with the whole consortium and has been taken up to be adapted locally by all the partners. In some settings this means training existing home based carers, in other it means training community members in villages or providing additional training for professionals or lay people already providing lifestyle change support. The actual training and implementation of profiling and coaching differs depending on the context. Since the activities implemented and evaluated in WP 3-4-5-6 are closely linked together (multicomponent intervention), there is some overlap in the reporting in the different WPs.

The overarching evaluation frameworks (WP 7) used by all partners are CFIR and RE-AIM. Both qualitative and quantitative inquiries are currently being undertaken to evaluate the implementation of the intervention and the different strategies. Whereas the project is making progress on this work and the protocols are in place, the actual concurrent evaluation for most sites is envisioned in the year 2020 and will best be reported in the 3rd periodic report.
In all locations, interventions on health promotion, profiling and coaching are currently being implemented and evaluated. Main impact reporting will be done in next periodic report (D 7.2) and at the end of the project.
Currently, all sites are starting to make an impact on people profiled and coached, on healthcare organisations that are strengthened to carry out their activities, on community organisations and members of the community who are educated on the risk factors of CVD’s and are involved and supported to participate in CVD prevention. All partners have also invested in networking, both locally, regionally and nationally, to try and safeguard the sustainability of the actions once the project will end.
Face to Face Nottingham, UK (Training workshop)
Face to Face Meeting, Kampala, Uganda
Face to Face Meeting, Antwerp, Belgium