Decentralized Screening for Hypertension, Diabetes Mellitus and Anemia through A Scalable Model Using Community Health Workers (CHWs) and Telehealth Integration-An Apollo Telehealth Study

Abstract

Background: The increasing burden of non-communicable diseases (NCDs) in India, such hypertension, diabetes, and anemia, continues to make it difficult for rural communities to get timely diagnostic and treatment services. The integration of digital health technologies, such telemedicine, remote monitoring systems, and point-of-care testing (POCT) devices, offers a potential solution to close these gaps, particularly in underserved areas. To extend NCD care to remote populations, Apollo Telehealth has implemented a model that integrates teleconsultations, tele-laboratories, and trained community health workers (CHWs). Aim: This study aimed to evaluate the feasibility, acceptability, and outcomes of delivering home-based screening for non-communicable diseases (NCDs) such as hypertension, diabetes, and anemia using trained Community Health Workers (CHWs) in underserved rural areas across India. Method: The study employed a decentralized, community-based model, where Community Health Workers (CHWs) carried out door-to-door screenings using point-of-care testing (POCT) devices. Individuals identified through screening referred to nearby primary healthcare facilities for further consultation and management. Study Design: This is an observational study which focuses on analyzing data collected from primary health centers (PHCs) across 17 districts in 9 states, using Electronic Health Records (EHRs). Study Plan and Duration: A total of 1,43,186 screenings were conducted from January 2022 to January 2025 across 9 states and 17 districts. Results: Findings revealed a significant proportion of newly diagnosed cases (new) for all three NCDs: hypertension (67.5%), diabetes (50.4%), and anemia (76.2%). Prevalence rates among those screened showed hypertension in 27.2%, diabetes in 8.8%, and anemia in 16.9%. Female participants showed a higher abnormality rate in all categories, especially for anemia (70.5% of abnormal cases). 86% of the participants expressed a favorable opinion about the use of POCTs, although concerns about device accuracy and follow-up care logistics were noted. Conclusion: This study demonstrates that home-based NCDs screening via trained CHWs, supported by Apollo Telehealth’s speciality teleconsultation and tele-laboratory services, is not only feasible but also addresses key barriers to healthcare access in resource-limited settings. The integration of digital tools, community engagement, and structured referral systems indicates a scalable model for strengthening early detection and continuity of care for NCDs in India.