Community-based screening for cardiovascular risk using a novel mHealth tool in rural Kenya

Background: An increasing burden of cardiovascular disease (CVD) in low-resource settings demands innovative public health approaches. Objectives: To design and test a novel mHealth tool for use by community health workers (CHWs) to identify individuals at high CVD risk who would benefit from education and/or pharmacologic interventions. Methods: We designed and implemented a novel two-way mobile phone application, “AFYACHAT,” to rapidly screen for CVD risk in rural Kenya. AFYACHAT collects and stores SMS text message data entered by a CHW on a subject’s age, sex, smoking, diabetes, and systolic blood pressure, and returns as SMS text message the category of 10-year CVD risk: “GREEN” (<10% 10 year risk of cardiovascular event), “YELLOW” (10 to <20%), “orange”(20 to <30%), or “RED” (≥30%). CHWs were equipped and trained to use an automated blood pressure device and the mHealth tool. Results: Five CHWs screened 2,865 subjects in remote rural communities in Kenya over a 22 month period (2015-17). The median age of subjects was 50 (IQR 43 to 60) and 1581 (55%) were female. Point prevalence of hypertension (systolic blood pressure>140mmHg), diabetes, and tobacco use were 23%, 3.2%, and 22%, respectively. Overall, the 10-year risk of CVD among patients was <10% in 2778 (97%) patients, 10 to <20% in 65 (2.3%), 20 to