Building Equitable Health Systems through Telemedicine and Community-Based Models for Hypertension and Diabetes Care

Cardiovascular diseases (CVDs) are the leading cause of non-communicable disease (NCD) morbidity and mortality in Sub-Saharan Africa (SSA). Evidence-based interventions to manage hypertension (HTN) and type 2 diabetes (DM) can prevent CVD, yet gaps in HTN-DM care drive a large preventable disease burden in SSA. BEACON-HD addresses three health system weaknesses that contribute to these gaps: (1) an overburdened health workforce; (2) a lack of health information systems to support care and service planning; and (3) clinic, rather than patient-centered service delivery models that limit communities’ access and engagement with care. Focusing on rural Rwanda and Uganda, BEACON-HD will adapt, evaluate, and promote the uptake of two proven implementation strategies—telemedicine with self-monitoring and community medication delivery—to strengthen health systems and equitably improve HTN-DM care. Both strategies directly address key health systems weaknesses by relieving workforce strain, enhancing health information use, and shifting services toward patient-centered, community-based care. Using participatory methods, we will form stakeholder advisory groups and co-adapt the strategies and co-design a telemedicine platform for rural Rwanda and Uganda. Next, we will implement both strategies through a hybrid type-2 cluster randomized trial and evaluate them across health systems, implementation, and effectiveness outcomes. Post-trial, we will leverage our social science expertise to explain how our strategies strengthened systems and patient self-management; identify contextual barriers and facilitators; and assess the strategies’ cost-effectiveness and long-term equity implications. Through a comprehensive dissemination, communication, and exploitation plan, we will ensure that the tools, guidelines, and evidence we generate through BEACON-HD are adopted, scaled, and sustained with health systems—advancing universal health coverage and contributing to SDG 3.4.