{
  "abstract": "Purpose The open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort is the first study to comprehensively investigate socioeconomic indicators, common chronic diseases and their risk factors in a remote rural setting in Lesotho. It serves as a platform for implementing nested trials using the Trials within Cohorts (TwiCs) design to assess community-based chronic care interventions. In this study, we present the cohort’s sociodemographic and chronic disease risk factor profile, including self-reported HIV prevalence and hypertension and diabetes care cascades.Participants Since February 2023, community health worker (CHWs) supported by a clinical decision support and data collection application have enrolled inhabitants from 103 randomly selected rural villages in Butha-Buthe and Mokhotlong districts in Northeast Lesotho. As of 31 May 2024, the cohort includes 5008 households with 14 735 participants (55% female, median age 19 years). The cohort’s socioeconomic status is low with an International Wealth Index of 26, a monthly household income of US$42.4 and low levels of formal education. Among the 7917 adult participants, 42.5% are overweight or obese, with higher rates among women, and 33.1% smoke tobacco, with higher rates among men. Self-reported HIV prevalence is 15.1% with a 98.4% treatment rate. Hypertension prevalence is 17% with a 56% control rate and diabetes prevalence is 4% with a 39% control rate.Findings to date The cohort’s low socioeconomic status is linked to multiple health risks including insufficient access to clean energy, essential healthcare services, adequate sanitary facilities and secure food supply. Besides the expected high HIV prevalence, we found significant hypertension, diabetes and cardiovascular risk factor prevalences. While treatment and control rates for diabetes and hypertension are higher than in similar settings, they remain below global targets.Future plans Ongoing cluster-randomised TwiCs, which will be completed in 2025, are assessing the effectiveness of community-based, CHW-led care interventions for diabetes and hypertension. CHWs will continue to closely monitor the cohort and integrate additional measurements such as HIV testing. This will provide further insights into the dynamics and interactions of chronic diseases and inform the development of future nested trials on innovative community-based prevention and care interventions.Trial registration number NCT05596773.",
  "authors": [
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "University of Basel, Basel, Switzerland"
      ],
      "name": "Felix Gerber"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "University of Basel, Basel, Switzerland"
      ],
      "name": "Giuliana Sanchez-Samaniego"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "University of Basel, Basel, Switzerland"
      ],
      "name": "Thesar Tahirsylaj"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "University of Basel, Basel, Switzerland"
      ],
      "name": "Thabo Ishmael Lejone"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "University of Basel, Basel, Switzerland"
      ],
      "name": "Tristan Lee"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "University of Basel, Basel, Switzerland"
      ],
      "name": "Fabian Raeber"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Mamakhala Chitja"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Malebona Mathulise"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Thuso Kabi"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Mosoetsi Mokaeane"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Malehloa Maphenchane"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Manthabiseng Molulela"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Mota Mota"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Sesale Masike"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Matumaole Bane"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Retselisitsoe Makabateng"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Makhebe Khomolishoele"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Mamoronts’ane Sematle"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Ravi Gupta"
    },
    {
      "affiliations": [
        "SolidarMed Lesotho, Maseru, Lesotho"
      ],
      "name": "Irene Ayakaka"
    },
    {
      "affiliations": [
        "Ministry of Health Lesotho, Maseru, Lesotho"
      ],
      "name": "Lebohang Sao"
    },
    {
      "affiliations": [
        "Ministry of Health Lesotho, Maseru, Lesotho"
      ],
      "name": "Mosa Tlahali"
    },
    {
      "affiliations": [
        "Ministry of Health Lesotho, Maseru, Lesotho"
      ],
      "name": "Sejojo Phaaroe"
    },
    {
      "affiliations": [
        "Ministry of Health Lesotho, Maseru, Lesotho"
      ],
      "name": "Malitaba Litaba"
    },
    {
      "affiliations": [
        "Ministry of Health Lesotho, Maseru, Lesotho"
      ],
      "name": "Madavida Mphunyane"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Dave Brian Basler"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Kevin Kindler"
    },
    {
      "affiliations": [
        "SolidarMed, Lucerne, Switzerland"
      ],
      "name": "Pauline Grimm"
    },
    {
      "affiliations": [
        "University of Basel, Basel, Switzerland",
        "Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Eleonora Seelig"
    },
    {
      "affiliations": [
        "Medical Outpatient Department and Hypertension Centre, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland",
        "Department of Cardiology, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Thilo Burkard"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "University of Basel, Basel, Switzerland"
      ],
      "name": "Matthias Briel"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "University of Basel, Basel, Switzerland"
      ],
      "name": "Frédérique Chammartin"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "University of Basel, Basel, Switzerland",
        "Oslo Center for Biostatistics and Epidemiology, Oslo University Hospital, University of Oslo, Oslo, Norway",
        "Electronic Health Records Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK"
      ],
      "name": "Alain Amstutz"
    },
    {
      "affiliations": [
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "University of Basel, Basel, Switzerland"
      ],
      "name": "Niklaus Daniel Labhardt"
    }
  ],
  "title": "Cohort profile: the open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort – design, baseline chronic disease risk factors and hypertension and diabetes care cascades",
  "uid": "9d6beddb-77a2-5b2e-8ff0-3e1cae8ef3b6"
}