Leveraging community-to-facility service provision to implement the World Health Organization HEARTS-D guidelines in Sylhet, Bangladesh for improving diabetes control and prevention (HEARTS-D for Bangladesh)
Study period: January 2025 to December 2029
Donor name: National Institute of Health (NIH), USA
Partner: Florida International University, Johns Hopkins University, University of Texas Health Science Center at Houston, World Health Organization
Project Description:
Background: Type 2 Diabetes (T2D) is increasing rapidly in low- and middle-income countries (LMICs), particularly in urban settings where the majority of affected individuals reside. Bangladesh has one of the highest burdens of T2D globally. The WHO HEARTS-D module is an evidence-based strategy aimed at strengthening diabetes management through standardized guidelines. However, its effective adoption into routine urban primary care in Bangladesh is hindered by systemic challenges, including limited integration with existing health systems, inadequate workforce capacity, and insufficient monitoring mechanisms.
Objective: This study aims to develop an optimized community-to-facility implementation model to strengthen urban healthcare for T2D management in Bangladesh using the WHO HEARTS-D module. This will also evaluate the optimized implementation model to investigate its impact and effectiveness on T2D care in an urban setting in Bangladesh.
Methods: We are conducting this implementation research in Sylhet City Corporation, Sylhet. The study population includes individuals aged 35 years or older who are at risk of developing T2D and reside in the study area. Additionally, the study includes participants from healthcare facilities, including healthcare providers and community stakeholders relevant to local T2D care (e.g., local physicians, non-physician health workers, community health workers, and local community leaders), to facilitate the qualitative research components of the study.
We are using mixed-methods design including both qualitative and quantitative research methodologies. First, a formative research method is used to identify barriers and facilitators for community-to-facility WHO HEARTS-D module implementation to design and optimize the initial implementation model. Concurrent program learning using qualitative research and outcome measurement while implementing the initial model in routine care settings are used to improve the model iteratively until a high coverage of T2D care using the WHO HEARTS-D module is achieved. This process will produce the final, optimized WHO HEARTS-D implementation model, developed from the perspective of sustainable scale-up. Second, the optimized implementation model will be evaluated by a type-2, hybrid implementation/effectiveness cluster-randomized trial. This trial will evaluate the program implementation and effectiveness of the final optimized model.
Significance: The study will help gather evidence to implement the WHO HEARTS-D guideline in community settings, leveraging a whole-of-community approach to effectively address the T2D burden in Bangladesh and other LMICs.