The goal of this proposal is to utilize a trans disciplinary implementation research approach to address the challenge of reducing CVD risk in Sub Saharan Africa and other low-resource settings. The central hypothesis is: group medical visits using microfinance groups will be effective and cost-effective in reducing CVD risk among individuals with diabetes and at high risk for diabetes in western Kenya. Eric Finkelstein, PhD will lead the economic evaluation for this effort. Specific activities include developing and adapting all forms to collect the cost data used in the cost-effectiveness analysis, working with local staff at each site to pilot test the forms and ensure cost data is being properly collected, providing reports documenting the fixed and variable costs associated with program delivery in each treatment arm, troubleshooting data collection issues throughout the study, and taking the lead role on the cost and cost-effectiveness evaluation documenting study findings. He will also take an active role in the design and overall evaluation of the intervention and will be an active participant in research meetings throughout the trial and in co-authoring other manuscripts at the direction of the overall PI. Gerald S. Bloomfield, MD, MPH will provide intellectual contribution to the overall design of the study including cardiovascular outcome measures, approach to sampling and clinical input into the group care model. He will be an active participant in research meetings throughout the design, implementation and evaluation phases of the study and in co-authoring manuscripts at the discretion of the overall PI. Dr. Edelman is an expert in group interventions in diabetes and hypertension. He will assist with the development of the group medical clinic intervention, as well as assisting in the interpretation of all analytic results and editing all manuscripts.