{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:15:43Z","timestamp":1785417343482,"version":"3.56.0"},"posted":{"date-parts":[[2026,6,5]]},"group-title":"Primary Care Research","reference-count":83,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/"}],"funder":[{"award":["R21TW010452"],"award-info":[{"award-number":["R21TW010452"]}],"id":[{"id":"https:\/\/ror.org\/02xey9a22","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006259","name":"Teva Pharmaceutical Industries","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006259","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100031950","name":"Resolve to Save Lives","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100031950","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Hypertension is the world\u2019s leading cause of death, and depression its leading cause of disability. Control rates for these non-communicable diseases (NCDs) are low in low- and middle-income countries (LMICs). Many LMICs have programs to screen and treat underserved communities for infectious diseases, but evidence to adapt them to treat NCDs is limited. We developed and tested a non-communicable disease program through Ghana\u2019s Community-Based Health Planning and Services (CHPS) primary care initiative.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We trained 8 CHPS nurses to diagnose and treat hypertension and depression through door-to-door screening and pharmacotherapy. Physician assistants provided telehealth supervision. We combined this treatment with volunteer counseling to boost medication adherence, improve mood, and change health behaviors. We called the 90-day intervention the CHPS Opportunity for Mentally and Behaviorally Integrated NCD Engagement (COMBINE).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We recruited 60 adults from 580 screened: 37 with hypertension (mean blood pressure (BP) of 149\/91 mm Hg) and 23 with depression (mean physician health questionnaire (PHQ-9) score of 13.3). After 90 days, 57\/60 (95%) completed the intervention: 32\/37 (86%) achieved blood pressure control (mean BP 122\/75 mm Hg), and 19 of 20 (95%) achieved depression control (mean PHQ-9 score 2.0). After 12 months, 51\/60 were retained: 33\/37 with hypertension (89%) and 18\/23 with depression (78%), with a mean BP of 121\/75 and PHQ-9 score of 1.4 respectively. All 51 (100%) achieved disease control at 12 months. 5 persons left by migration and 4 by escalation to higher-level care.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The COMBINE model achieved high levels of diagnosis, care retention, and disease control, with minimal adverse events, in a remote setting with limited usual NCD care. This model suggests a novel means to improve the care cascade for these and other noncommunicable diseases through existing non-physician care models in LMICs, warranting further controlled testing at scale.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>What Is Already Known on This Topic?<\/jats:title>\n                  <jats:p>Hypertension and depression are the leading causes of global death and disability respectively. In Ghana as in many low- and middle-income countries, evidence shows rural non-physician health workers can proactively screen persons with these and other noncommunicable diseases and refer them to higher-level clinics. However, such clinics are often few and distant from rural areas, limiting access and disease control.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>What Does This Study Add?<\/jats:title>\n                  <jats:p>Our program is the first to test the hypothesis that nurses and volunteers in Ghana\u2019s primary care program can treat hypertension and depression in remote villages - through pharmacotherapy and behavior counseling. We found that 95% of trial participants completed the 90-day intervention, and 91% achieved disease control. At 1 year, 85% remained in care, of which 100% achieved disease control. These retention and control rates meet or exceed that of higher-level health centre care.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>How Might This Study Affect Policy?<\/jats:title>\n                  <jats:p>If effective at scale in a randomized trial, this intervention could allow CHPS to markedly increase awareness, treatment, and control rates for hypertension and depression in Ghana. Its focus on promoting behaviors relevant to many non-communicable diseases - such as physical exercise and alcohol and tobacco cessation - may make it applicable to the concurrent management of multiple chronic conditions. Further, this care model could be leveraged in other health systems with a national non-physician rural health program, improving noncommunicable disease control worldwide.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.06.03.26354834","type":"posted-content","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T22:20:14Z","timestamp":1780698014000},"source":"Crossref","is-referenced-by-count":0,"title":["Integrating a Non-Communicable Disease Care Cascade within Ghana\u2019s Community-Based Health Planning and Services (CHPS) Program: the COMBINE Pilot Implementation Trial"],"prefix":"10.64898","author":[{"given":"David J","family":"Heller","sequence":"first","affiliation":[{"name":"Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yehia","family":"Elkersh","sequence":"additional","affiliation":[{"name":"School of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Engelbert A","family":"Nonterah","sequence":"additional","affiliation":[{"name":"Navrongo Health Research Centre, Research and Development Division, Ghana Health Service, Navrongo, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Kuwolamo","sequence":"additional","affiliation":[{"name":"Navrongo Health Research Centre, Research and Development Division, Ghana Health Service, Navrongo, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol R","family":"Horowitz","sequence":"additional","affiliation":[{"name":"Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan E","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Awine","sequence":"additional","affiliation":[{"name":"Navrongo Health Research Centre, Research and Development Division, Ghana Health Service, Navrongo, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usha","family":"Govindarajulu","sequence":"additional","affiliation":[{"name":"Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison P","family":"Squires","sequence":"additional","affiliation":[{"name":"NYU Rory Meyers College of Nursing, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedict","family":"Weobong","sequence":"additional","affiliation":[{"name":"School of Global Health, York University, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond A","family":"Aborigo","sequence":"additional","affiliation":[{"name":"Navrongo Health Research Centre, Research and Development Division, Ghana Health Service, Navrongo, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026060901351073000_2026.06.03.26354834v1.1","unstructured":"Fact Sheet: Noncommunicable Diseases. 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