A Feasibility Study of Supply and Demand for Diabetes Prevention Programs in North Carolina

Willingness to pay for community delivery of antiretroviral treatment in urban Tanzania: a cross-sectional survey

Community health worker (CHW)-led community delivery of HIV antiretroviral therapy (ART) could increase ART coverage and decongest healthcare facilities. It is unknown how much patients would be willing to pay to receive ART at home and, thus, whether ART community delivery could be self-financing. Set in Dar es Salaam, this study aimed to determine patients’ willingness to pay (WTP) for CHW-led ART community delivery. We sampled ART patients living in the neighbourhoods surrounding each of 48 public-sector healthcare facilities in Dar es Salaam. We asked participants (N = 1799) whether they (1) preferred ART community delivery over standard facility-based care, (2) would be willing to pay for ART community delivery and (3) would be willing to pay each of an incrementally increasing range of prices for the service. 45.0% (810/1799; 95% CI: 42.7—47.3) of participants preferred ART community delivery over standard facility-based care and 51.5% (417/810; 95% CI: 48.1—55.0) of these respondents were willing to pay for ART community delivery. Among those willing to pay, the mean and median amount that participants were willing to pay for one ART community delivery that provides a 2-months’ supply of antiretroviral drugs was 3.61 purchasing-power-parity-adjusted dollars (PPP$) (95% CI: 2.96–4.26) and 1.27 PPP$ (IQR: 1.27–2.12), respectively. An important limitation of this study is that participants all resided in neighbourhoods within the catchment area of the healthcare facility at which they were interviewed and, thus, may incur less costs to attend standard facility-based ART care than other ART patients in Dar es Salaam. While there appears to be a substantial WTP, patient payments would only constitute a minority of the costs of implementing ART community delivery. Thus, major co-financing from governments or donors would likely be required.

Scaling Up Diabetes Prevention Programs in North Carolina: Perceptions of Demand From Potential Program Recipients and Providers

Purpose

The purpose of this study was to assess factors that influence demand for the Diabetes Prevention Program (DPP) from the perspectives of potential program participants and providers.

Methods

A qualitative study guided by a conceptual framework was conducted with potential DPP participants and potential DPP providers. Five focus groups with potential participants (n = 37) and key informant interviews with potential providers (n = 14) were conducted in community settings across North Carolina.

Results

Although providers considered prediabetes to be an important health problem, potential DPP participants expressed less urgency related to a diagnosis of prediabetes. Potential participants felt that they were more likely to adopt diabetes prevention programs if affordable and convenient. For potential program providers, funding, collaboration, and staff support were key considerations for DPP adoption. Providers were supportive of DPP features; however, there was concern from both stakeholders on retention in a 16-week program. Both groups cited transportation, cost, and health insurance reimbursement as existing barriers to the uptake of these programs.

Conclusion

This qualitative study highlights important considerations for scaling up diabetes prevention programs in community settings, including what constraints agencies face in adopting programs, the perceived demand and programmatic needs for these services by customers, and the need for improving patient education on prediabetes. This implementation science study allows us to increase the potential to scale up and sustain diabetes prevention programs that fit available resources and customer needs.