National Institute for Health and Care Research Global Health Research Centre for Multiple Long-Term Conditions

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Conditions studied: Chronic Conditions, Multiple, Diseases of the Circulatory System, Diseases of the Respiratory System, Endocrine, Nutritional and Metabolic Diseases, Mental, Behavioral and Neurodevelopmental Disorders, Diseases of the Musculoskeletal System and Connective Tissue, Diseases of the Ear and Mastoid Process, Diseases of the Eye and Adnexa

In brief

Multiple Long-Term Conditions (MLTC), defined as the coexistence of two or more chronic conditions, is increasingly prevalent in India. Despite this, the healthcare system remains largely focused on single-disease management, underscoring the urgent need for integrated, patient-centred approaches that are context-specific, equitable, and resource-sensitive. India's public health infrastructure is undergoing significant reform through the Ayushman Bharat Yojana, which aims to upgrade 150,000 sub-centres and primary health centres into Health and Wellness Centres (HWCs). These centres are designed to provide comprehensive care including prevention, treatment, and rehabilitation to underserved populations. This transformation presents a strategic opportunity to embed multi-morbidity care into the evolving system, supported by the establishment of a Global Health Research Centre dedicated to MLTC. The NIHR Global Health Research Centre for Multiple Long-Term Conditions aims to transform the health system in India and Nepal by improving care for individuals living with MLTC. With chronic conditions on the rise due to epidemiological transitions, particularly among adults aged ≥40, there is an urgent need for integrated, people-centred care models. This project is being implemented in Anakapalli district (Andhra Pradesh), Jodhpur (Rajasthan), Sonipat (Haryana) and Nepal, encompassing both rural and urban contexts. The study is conducted among adult patients with MLTCs attending rural primary providers (Medical officers and Staff Nurse) delivering services at these facilities in India and Nepal. The intervention comprises an electronic decision support system (EDSS) to facilitate evidence-based clinical decision-making, assisted telemedicine model to enable timely specialist consultations, and a patient-facing mobile application-supported by community champions and care coordinators to enhance care coordination, self-management, and treatment adherence. At this stage, we have completed the case-mix and health facility assessments, alongside the in-depth interviews to identify challenges faced by patients, caregivers, and health care providers. Currently, we are pilot testing the health intervention in 4 PHCs in India and 2 PHCs in Nepal among 180 participants (30 participants per site). Findings from this pilot will inform refinement of the intervention, study tools, and implementation strategies, and will provide critical evidence on contextual adaptability to support the design of a subsequent cluster randomized controlled trial (RCT). In the full RCT, we will evaluate the effectiveness of a health system intervention comprising an electronic clinical decision support system, assisted telemedicine, a patient-facing application, and community champions. The study will be conducted across selected sites in India and Nepal using a cluster randomized controlled design, in which Primary Health Centres (PHCs) are allocated to either the intervention or usual care arm. The intervention includes structured clinical workflows, a digital decision support system, assisted telemedicine, and patient-facing mobile health tools to strengthen continuity and coordination of care. Participants will engage with these components over a six-month implementation period. Data collection will include participant surveys and qualitative interviews, complemented by routine supervision checklists and system usage analytics to assess implementation processes and usability. The study findings will generate robust evidence to inform scalable and context-appropriate models of integrated care for multiple long-term conditions (MLTCs) in primary care settings in low- and middle-income countries. By embedding digital tools and strengthening PHC systems, the intervention aims to improve quality of life, reduce fragmentation of care, and establish a sustainable model for MLTC management.

Key facts

Study ID: NCT07582380
Run by: Centre for Chronic Disease Control, India
People needed: 3600
Starts: 2026-05-05
Expected to finish: 2028-08-30
Last updated by the study team: 2026-05-12

Who can join

Age: 40 and older, up to 100. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

Adults aged 40 years or above
Attending the Primary Health Centre (PHC) during the enrollment period
Diagnosed with two or more of the following chronic conditions:
Hypertension
Diabetes mellitus
Depression
Anxiety
Chronic obstructive pulmonary disease (COPD)
Asthma
Vision impairment
Hearing impairment
Osteoarthritis
Chronic back pain

You may not qualify if…

Age < 40 years
Presence of only one or none of the listed chronic conditions
Pregnant or breastfeeding women
Severe cognitive impairment or dementia that prevents informed consent or or reliable participation
Bedridden or terminally ill individuals with a life expectancy < 6 month
Current participation in another clinical or interventional research study may interfere with study outcomes
Severe psychiatric illness (e.g., psychosis or bipolar disorder) other than depression or anxiety
Unable or unwilling to provide written informed consent
Severe communication barriers that prevent participation in interviews or questionnaires, even with assistance

Where it is running

Buchhayyapeta Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Burugupalem Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Butchimpeta Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Cheedikada Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Chowduwada Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Chuchukonda Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Devarapalli Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Dimili Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Gavaravaram Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Golugonda Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Gullepalli Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Gunupudi Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Haripalem Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
K D Peta Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Kasimkota Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
L V Palem Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Mangavaram Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Pedagogada Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Penugollu Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Ravikamatham Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Sabbavaram Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
THAGARAMPUDI Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Thallapalem Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Thurakalapudi Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India
Atchuthapuram Primary Health Care Center, Narsīpatnam, Anakapalli 531115 — Visakhapatnam, Andhra Pradesh, India

Full record on ClinicalTrials.gov

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