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Bhattarai S, Skovlund E, Shrestha A, Mjølstad BP, Åsvold BO, Sen A. Impact of a community health worker led intervention for improved blood pressure control in urban Nepal: an open-label cluster randomised controlled trial. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 29:100461. [PMID: 39220804 PMCID: PMC11364134 DOI: 10.1016/j.lansea.2024.100461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/26/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
Background Effective control of hypertension remains challenging in low and middle-income countries. We tested the effectiveness of comprehensive approaches to hypertension management including six home visits by community health workers with regular follow up by a trained healthcare provider on blood pressure levels in Nepal. Methods We implemented a non-blinded, open-label, parallel-group, two-arm cluster randomised controlled trial, with 1:1 allocation ratio in Budhanilakantha municipality, Kathmandu, Nepal. Ten public health facilities and their catchment area were randomly allocated to receive comprehensive intervention or only usual hypertension care. We recruited 1252 individuals aged 18 years and older with hypertension. The primary outcome was systolic blood pressure. Secondary outcomes were diastolic blood pressure, proportion with controlled blood pressure, waist to hip ratio, body mass index, physical activity, diet quality score, daily salt intake, adherence to antihypertensives, hypertension knowledge and perceived social support. Primary analysis was by intention-to-treat using a linear mixed model. Findings Participants were, on average 57 years old, 60% females, 84% married, 54% Brahmin/Chettri ethnicity and 33% were illiterate. The decrease in mean systolic blood pressure (1.7 mm Hg, 95% CI -0.1, 3.4) and diastolic blood pressure (1.6 mm Hg, 95% CI 0.5, 2.6) was more in the intervention arm compared to the control. The proportion with blood pressure control (OR 1.5 95% CI 1.0, 2.1) and engaging in adequate physical activity (≥600 Metabolic equivalents of task per week) (OR 2.2, 95% CI 1.6, 3.1) were higher in the intervention arm compared to control. The change in hypertension knowledge score was higher and daily salt intake was lower in the intervention arm compared to control. Waist to hip ratio increased more and global dietary requirement scores decreased more in the intervention group and there was no effect on the body mass index and adherence to antihypertensives. Interpretation Community health workers facilitated home support and routine follow-up care by healthcare providers was effective in controlling blood pressure in urban Nepal. These findings suggest comprehensive interventions targeting individual, community and health system barriers are feasible in low resource settings, but larger implementation trials are needed to inform future scale-up. Funding This work was supported by Norwegian University of Science and Technology, Trondheim, Norway (Project number 981023100).
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Affiliation(s)
- Sanju Bhattarai
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Institute for Implementation Science and Health, Kathmandu, Nepal
| | - Eva Skovlund
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Archana Shrestha
- Institute for Implementation Science and Health, Kathmandu, Nepal
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, USA
| | - Bente Prytz Mjølstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Abhijit Sen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Center for Oral Health Services and Research (TkMidt), Trondheim, Norway
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Yap HJ, Lim JJJ, Tan SYD, Ang CS. Effectiveness of digital health interventions on adherence and control of hypertension: a systematic review and meta-analysis. J Hypertens 2024; 42:1490-1504. [PMID: 38973553 DOI: 10.1097/hjh.0000000000003793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Hypertension, a risk factor for developing cardiovascular disease, is becoming increasingly prevalent worldwide. Digital health is now widely utilized for hypertension management, and numerous studies have assessed its effectiveness. OBJECTIVE The review aims to analyse the effectiveness of digital health (i.e., mobile health (mHealth), telehealth, and the combination of mHealth & telehealth) on hypertensive patients, concerning three key areas: clinical outcomes, medication adherence, and adherence to lifestyle changes, as compared to standard care. METHODS The review followed the PRISMA framework. Eight electronic databases were scanned for randomized control trials focusing on the effects of mHealth or telehealth on hypertensive patients, published between 2010 and 2023. All processes were conducted by the first two authors independently. A meta-analysis was conducted for quantitative data, while a narrative synthesis was conducted for qualitative data. RESULTS In total, 74 studies involving 92 686 participants were identified. The meta-analysis favoured the interventions, revealing a significant decrease in systolic blood pressure and diastolic blood pressure for mHealth, telehealth and mHealth & telehealth groups. Nevertheless, medication adherence showed improvement only in the mHealth group, while blood pressure control showed improvement in both mHealth and mHealth & telehealth groups, and BMI showed improvement only in the mHealth group. Evidence for adherence to physical activity and DASH diet/salt intake remained inconclusive. CONCLUSION In general, mHealth and telehealth have demonstrated their merits in improving the clinical outcomes of hypertensive patients.
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Affiliation(s)
- Hao Jeun Yap
- Department of Pharmacy, National University of Singapore
| | | | | | - Chin Siang Ang
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Mbuthia GW, Mwangi J, Magutah K, Oguta JO, Ngure K, McGarvey ST. Preliminary efficacy of a community health worker homebased intervention for the control and management of hypertension in Kiambu County, Kenya- a randomized control trial. PLoS One 2024; 19:e0293791. [PMID: 39208336 PMCID: PMC11361652 DOI: 10.1371/journal.pone.0293791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/06/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION In Sub Saharan Africa, there is a growing burden of non-communicable diseases, which poses a big challenge to the resource-limited health system in these settings. OBJECTIVE The aim of this study was to determine the feasibility and preliminary efficacy of a community health workers (CHWs) home-based lifestyle interventions to improve blood pressure (BP) control and body composition among hypertensive patients in low-income populations of Kiambu County, Kenya. METHODS This was a randomized controlled trial (RCT) involving 80 patients with uncontrolled high BP (systolic BP (SBP) ≥140mmHg and/or diastolic BP (DBP) ≥90) randomized to either a CHW homebased intervention or a usual care (control) arm and followed up for 6 months. The intervention involved monthly CHW home-visits for health education and audits on behavioral risk factors that affect BP. An adapted WHO stepwise questionnaire and international physical activity questionnaire was used to collect data on behavioral cardiovascular risk factors. To assess the main outcomes of BP, body mass index (BMI) and waist-height-ratio (WHtR), a survey was conducted at baseline, 3 months, and 6 months. Data regarding univariate, bivariate and multivariate (repeated measurements between and within groups) analysis at 5% level of significance were analyzed using STATA 18. Generalized estimating equations (GEE) for repeated measures were used to estimate changes in BP, BMI and WHtR, and to examine the association between the CHW intervention and BP control. RESULTS The study revealed that 77.5% and 92.5% of the participants in usual care and intervention groups completed the follow-up, respectively. After 6 months of follow-up, there was a reduction in the mean SBP and DBP for both arms, and reductions in BMI and WHtR only in the intervention arm. The adjusted mean reduction in SBP (-8.4 mm Hg; 95% CI, -13.4 to -3.3; P = 0.001) and DBP (-5.2 mm Hg 95% CI, -8.3 to -2.0; P<0.001) were significantly higher in the intervention group compared to the control group. The proportion of participants who achieved the controlled BP target of <140/90 mm Hg was 62.2% and 25.8% for the intervention and usual care arm, respectively. The proportion with controlled BP was significantly higher in the intervention arm compared to the usual care arm after adjusting for baseline covariates (AOR 2.8, 95% CI 1.3-6.0, p = 0.008). There was no significant effect of the intervention on BMI and WHtR. CONCLUSION A home-based CHW intervention was significantly associated with reduction in BP among hypertensive patients compared to usual care. Future fully powered RCTs to test the effectiveness of such interventions among low-income populations are recommended. TRIAL REGISTRATION Trial registration number: PACTR202309530525257.
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Affiliation(s)
- Grace Wambura Mbuthia
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - James Mwangi
- School of Public Health and Community Development, Maseno University, Kisumu, Kenya
- World Health Organisation Somalia, ATMIS Protected Area, Mogandishu, Somalia
| | - Karani Magutah
- School of Medicine, College of Health Sciences, Moi University Eldoret, Eldoret, Kenya
| | - James Odhiambo Oguta
- Division of Population Health, Sheffield Centre for Health and Related Research, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Kenneth Ngure
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Stephen T. McGarvey
- Department of Epidemiology, School of Public Health and Department of Anthropology, International Health Institute, Brown University, Providence, RI, United States of America
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Mihevc M, Virtič Potočnik T, Zavrnik Č, Klemenc-Ketiš Z, Poplas Susič A, Petek Šter M. Managing cardiovascular risk factors with telemedicine in primary care: A systematic review and meta-analysis of patients with arterial hypertension and type 2 diabetes. Chronic Illn 2024:17423953241277896. [PMID: 39194352 DOI: 10.1177/17423953241277896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
OBJECTIVES To review the effect of telemedicine interventions on cardiovascular risk factors control in people with arterial hypertension (AH), type 2 diabetes (T2D), or both in primary care. METHODS We conducted a systematic review in February 2024 using PubMed/MEDLINE, Cochrane Library, and EMBASE databases. We included randomised controlled trials from 2010 onwards, lasting ≥3 months, comparing telemedicine to standard care for managing cardiovascular risk factors in adults with AH, T2D, or both. RESULTS Among 1803 records, 54 were included. Telemonitoring with teleconsultations showed the best outcomes. For AH, systolic blood pressure decreased by -5.63 mmHg (95% CI -9.13 to -2.13) at 6 months and -5.59 mmHg (95% CI -10.03 to -1.14) at 12 months compared to standard care. For T2D, HbA1c decreased by -0.45% (95% CI -0.90 to 0.00) at 6 months and -0.18% (95% CI -0.41 to 0.05) at 12 months compared to standard care. Blood glucose self-monitoring was as effective as telemonitoring for T2D at 6 months. The effect on diastolic blood pressure, low-density lipoprotein, triglycerides, and body mass index was non-significant. DISCUSSION Telemedicine offers short-term benefits but lacks long-term effectiveness. Optimal outcomes require a combined telemedicine approach, health education co-intervention, ≥12-month follow-up, and careful patient selection.
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Affiliation(s)
- Matic Mihevc
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tina Virtič Potočnik
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, Department of Family Medicine, University of Maribor, Maribor, Slovenia
| | - Črt Zavrnik
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Zalika Klemenc-Ketiš
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, Department of Family Medicine, University of Maribor, Maribor, Slovenia
| | - Antonija Poplas Susič
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Marija Petek Šter
- Medical Faculty, Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
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Hinneh T, Boakye H, Metlock F, Ogungbe O, Kruahong S, Byiringiro S, Dennison Himmelfarb C, Commodore-Mensah Y. Effectiveness of team-based care interventions in improving blood pressure outcomes among adults with hypertension in Africa: a systematic review and meta-analysis. BMJ Open 2024; 14:e080987. [PMID: 39019631 DOI: 10.1136/bmjopen-2023-080987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVE We evaluated the effectiveness of team-based care interventions in improving blood pressure (BP) outcomes among adults with hypertension in Africa. DESIGN Systematic review and meta-analysis. DATA SOURCE PubMed, CINAHL, EMBASE, Cochrane Library, HINARI and African Index Medicus databases were searched from inception to March 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included randomised controlled trials (RCTs) and pre-post study designs published in English language focusing on (1) Adults diagnosed with hypertension, (2) Team-based care hypertension interventions led by non-physician healthcare providers (HCPs) and (3) Studies conducted in Africa. DATA EXTRACTION AND SYNTHESIS We extracted study characteristics, the nature of team-based care interventions, team members involved and other reported secondary outcomes. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs and the National Heart, Lung, and Blood Institute assessment tool for pre-post studies. Findings were summarised and presented narratively including data from pre-post studies. Meta-analysis was conducted using a random effects model for only RCT studies. Overall certainty of evidence was determined using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool for only the primary outcome (systolic BP). RESULTS Of the 3375 records screened, 33 studies (16 RCTs and 17 pre-post studies) were included and 11 RCTs were in the meta-analysis. The overall mean effect of team-based care interventions on systolic BP reduction was -3.91 mm Hg (95% CI -5.68 to -2.15, I² = 0.0%). Systolic BP reduction in team-based care interventions involving community health workers was -4.43 mm Hg (95% CI -5.69 to -3.17, I² = 0.00%) and nurses -3.75 mm Hg (95% CI -10.62 to 3.12, I² = 42.0%). Based on the GRADE assessment, we judged the overall certainty of evidence low for systolic BP reduction suggesting that team-based care intervention may result in a small reduction in systolic BP. CONCLUSION Evidence from this review supports the implementation of team-based care interventions across the continuum of care to improve awareness, prevention, diagnosis, treatment and control of hypertension in Africa. PROSPERO registration number CRD42023398900.
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Affiliation(s)
- Thomas Hinneh
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hosea Boakye
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Faith Metlock
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Suratsawadee Kruahong
- Faculty of Nursing, Department of Nursing, Department of Surgical Nursing, Mahidol University, Bangkok, Thailand
| | - Samuel Byiringiro
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
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Sakima A, Akagi Y, Akasaki Y, Fujii T, Haze T, Kawakami-Mori F, Kitajima K, Kobayashi Y, Matayoshi T, Sakaguchi T, Yamazato M, Abe M, Ohya Y, Arima H. Effectiveness of digital health interventions for telemedicine/telehealth for managing blood pressure in adults: a systematic review and meta-analysis. Hypertens Res 2024:10.1038/s41440-024-01792-7. [PMID: 38977877 DOI: 10.1038/s41440-024-01792-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 06/15/2024] [Indexed: 07/10/2024]
Abstract
This systematic review and meta-analysis included randomized controlled trials or observational studies that compare digital health interventions (DHIs) for telemedicine/telehealth versus usual care for managing blood pressure (BP) in adults. We searched PubMed, Cochrane CENTRAL, and IchuShi-Web, and used a random-effects meta-analysis of the weighted mean difference (MD) between the comparison groups to pool data from the included studies. The outcome included the pooled MD of office BP from baseline to each follow-up period. This meta-analysis considered 117 studies with 68677 participants as eligible. The 3-month intervention period reduced office systolic BP (SBP) compared with usual care in 38 studies (MD: -3.21 mmHg [95% confidence interval: -4.51 to -1.90]), with evidence of heterogeneity. Office SBP across intervention periods demonstrated comparable effects (3-, 6- [54 studies], 12- [43 studies], and >12-month periods [9 studies]). The benefits for office diastolic BP were similar to those for office SBP. Additionally, the interventions significantly reduced the office SBP compared with the control, regardless of the mode of intervention delivery (smartphone apps [38 studies], text messages [35 studies], and websites [34 studies]) or type of facility (medical [74 studies] vs. non-medical [33 studies]). The interventions were more effective in 41 hypertension cohorts compared with 66 non-hypertension cohorts (-4.81 mmHg [-6.33, -3.29] vs. -2.17 mmHg [-3.15, -1.19], P = 0.006 for heterogeneity). In conclusion, DHIs for telemedicine/telehealth improved BP management compared with usual care. The effectiveness with heterogeneity should be considered, as prudent for implementing evidence-based medicine. This meta-analysis considered 117 studies with 68677 participants eligible. The DHIs for telemedicine/telehealth reduced office BP compared with usual care, regardless of intervention duration, intervention delivery mode, facility type, and cohort type. Additionally, the DHIs reduced the risk of uncontrolled BP compared with usual care, regardless of intervention duration, intervention delivery mode, and facility type. BP blood pressure, DHI digital health intervention, MD mean difference, RR risk ratio, SBP systolic blood pressure.
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Affiliation(s)
- Atsushi Sakima
- Health Administration Center, University of the Ryukyus, Okinawa, Japan.
| | - Yuya Akagi
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichi Akasaki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takako Fujii
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tatsuya Haze
- YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Kanagawa, Japan
| | - Fumiko Kawakami-Mori
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Ken Kitajima
- Department of Cardiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yusuke Kobayashi
- Co-Creation Innovation Center, Yokohama City University, Kanagawa, Japan
| | | | - Takashi Sakaguchi
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Makiko Abe
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yusuke Ohya
- University Hospital of the Ryukyus, Okinawa, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Nyame S, Boateng D, Heeres P, Gyamfi J, Gafane-Matemane LF, Amoah J, Iwelunmor J, Ogedegbe G, Grobbee D, Asante KP, Klipstein-Grobusch K. Community-Based Strategies to Improve Health-Related Outcomes in People Living With Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Glob Heart 2024; 19:51. [PMID: 38883258 PMCID: PMC11177843 DOI: 10.5334/gh.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/18/2024] [Indexed: 06/18/2024] Open
Abstract
Background Individuals living with hypertension are at an increased risk of cardiovascular- and cerebrovascular-related outcomes. Interventions implemented at the community level to improve hypertension control are considered useful to prevent cardiovascular and cerebrovascular events; however, systematic evaluation of such community level interventions among patients living in low- and middle-income countries (LMICs) is scarce. Methods Nine databases were searched for randomized controlled trials (RCTs) and cluster randomized control trials (cRCTs) implementing community level interventions in adults with hypertension in LMICs. Studies were included based on explicit focus on blood pressure control. Quality assessment was done using the Revised Cochrane Risk of Bias tool for randomized trials (ROBS 2). Results were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Fixed-effect meta-analyses were conducted for studies that reported continuous outcome measures. Results We identified and screened 7125 articles. Eighteen studies, 7 RCTs and 11 cRCTs were included in the analysis. The overall summary effect of blood pressure control was significant, risk ratio = 1.48 (95%CI = 1.40-1.57, n = 12). Risk ratio for RCTs was 1.68 (95%CI = 1.40-2.01, n = 5), for cRCTs risk ratio = 1.46 (95%CI = 1.32-1.61, n = 7). For studies that reported individual data for the multicomponent interventions, the risk ratio was 1.27 (95% CI = 1.04-1.54, n = 3). Discussion Community-based strategies are relevant in addressing the burden of hypertension in LMICs. Community-based interventions can help decentralize hypertension care in LMIC and address the access to care gap without diminishing the quality of hypertension control.
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Affiliation(s)
- Solomon Nyame
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
- Kintampo Health Research Centre, Ghana
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Pauline Heeres
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Joyce Gyamfi
- Department of Global Health, New York University School of Global Public Health, New York University, New York, NY, USA
| | - Lebo F. Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, North-West Province, South Africa
| | | | - Juliet Iwelunmor
- Saint Louis University College for Public Health and Social Justice, St. Louis, MO, USA
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
| | - Diederick Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | | | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Kwiringira A, Migisha R, Bulage L, Kwesiga B, Kadobera D, Upenytho G, Mbaka P, Harris JR, Hayes D, Ario AR. Group-based Education and monitoring program delivered by community health workers to improve control of high blood pressure in island districts of lake victoria, Uganda. BMC PRIMARY CARE 2024; 25:191. [PMID: 38807067 PMCID: PMC11134886 DOI: 10.1186/s12875-024-02444-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Individuals living in communities with poor access to healthcare may be unaware of their high blood pressure (BP). While the use of community health workers (CHWs) can address gaps in human resources for health, CHWs in Uganda have not been used previously for BP screening and management. We report the results of an initiative to train CHWs to evaluate BP and to administer group-based education in Kalangala and Buvuma Island Districts of Lake Victoria, Uganda. METHODS We randomly selected 42 of 212 villages. We trained CHWs based in island districts on measuring BP. CHWs visited all households in the selected villages and invited all adults ≥ 18 years to be screened for high BP. We used the World Health Organization's STEPwise tool to collect data on demographic and behavioral characteristics and BP measurements. High blood pressure was defined as systolic BP (SBP) ≥ 140 mm Hg and/or diastolic BP (DBP) ≥ 90 mm Hg over three readings. CHWs created and led fortnight support groups for individuals identified with high blood pressure at baseline. At each group meeting, CHWs re-measured BP and administered an intervention package, which included self-management and lifestyle education to participants. The paired t-test was used to compare mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after the intervention. Generalized estimating equations (GEE) were used to model longitudinal changes in BP. RESULTS We trained 84 CHWs to measure BP and deliver the intervention package. Among 2,016 community members, 570 (28.3%) had high blood pressure; of these, 63 (11.1%) had a previous diagnosis of hypertension. The comparison of SBP and DBP before and after the intervention revealed significant reductions in mean SBP from 158mmHg (SD = 29.8) to 149 mmHg (SD = 29.8) (p < 0.001) and mean DBP from 97mmHg (SD = 14.3) to 92mmHg (p < 0.001). GEE showed decreases of -1.133 (SBP) and - 0.543 mmHg (DBP)/fortnight. CONCLUSION High BP was common but previously undiagnosed. The CHW-led group-based self-management and education for controlling high BP was effective in the island districts in Uganda. Scaling up the intervention in other hard-to-reach districts could improve control of high BP on a large scale.
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Affiliation(s)
- Andrew Kwiringira
- Uganda Public Health Fellowship Program, Kampala, Uganda.
- Uganda National Institute of Public Health, Kampala, Uganda.
- Department of Planning Financing and Policy, Ministry of Health, Kampala, Uganda.
| | - Richard Migisha
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - George Upenytho
- Department of Community Health, Ministry of Health, Kampala, Uganda
| | - Paul Mbaka
- Department of Planning Financing and Policy, Ministry of Health, Kampala, Uganda
| | - Julie R Harris
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Donald Hayes
- Division of Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alex R Ario
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
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Gafane-Matemane LF, Craig A, Kruger R, Alaofin OS, Ware LJ, Jones ESW, Kengne AP. Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities. J Hum Hypertens 2024:10.1038/s41371-024-00913-6. [PMID: 38698111 DOI: 10.1038/s41371-024-00913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
Recent global and regional reports consistently confirm the high and increasing prevalence of hypertension in sub-Saharan Africa (SSA), with poor detection, treatment, and control rates. This narrative review summarises the burden of hypertension in SSA and recent findings from community-based hypertension management strategies. We further outline prominent risk factors according to recent data and associated underlying mechanisms for hypertension development. An extensive review of literature showed that most countries have reported on the prevalence of hypertension during 2017-2023, despite limitations linked to the lack of nationally representative studies, heterogeneity of sampling and data collection methods. Task-shifting approaches that assign roles to model patients and community health workers reported improved linkage to healthcare services and adherence to medication, with inconsistent findings on blood pressure (BP)-lowering effects over time. The regularly reported risk factors include unhealthy diet, sedentary lifestyle, increased adiposity and underweight, ageing, level of education, and/or income as well as psychosocial factors. Newer data on the pathophysiological mechanisms leading to hypertension and potential areas of intervention are reported from children and adults and include, among others, salt-handling and volume overload, endothelial function, BP dipping patterns and the role of human immunodeficiency virus . To conclude, significant strides have been made in data reporting from SSA on the burden of hypertension in the region as well as biomarker research to improve understanding and identification of areas of intervention. However, gaps remain on linkage between knowledge generation, translation, and implementation research. Coordinated studies addressing both discovery science and public health are crucial to curb hypertension development and improve management in SSA.
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Affiliation(s)
- Lebo F Gafane-Matemane
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa.
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa.
| | - Ashleigh Craig
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa
| | - Omotayo S Alaofin
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University, Mthatha, South Africa
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10
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Ye J, Sanuade OA, Hirschhorn LR, Walunas TL, Smith JD, Birkett MA, Baldridge AS, Ojji DB, Huffman MD. Interventions and contextual factors to improve retention in care for patients with hypertension in primary care: Hermeneutic systematic review. Prev Med 2024; 180:107880. [PMID: 38301908 PMCID: PMC10919242 DOI: 10.1016/j.ypmed.2024.107880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Regular engagement over time in hypertension care, or retention, is a crucial but understudied step in optimizing patient outcomes. This systematic review leverages a hermeneutic methodology to identify, evaluate, and quantify the effects of interventions and contextual factors for improving retention for patients with hypertension. METHODS We searched for articles that were published between 2000 and 2022 from multiple electronic databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and WHO International Trials Registry. We followed the latest version of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline to report the findings for this review. We also synthesized the findings using a hermeneutic methodology for systematic reviews, which used an iterative process to review, integrate, analyze, and interpret evidence. RESULTS From 4686 screened titles and abstracts, 18 unique studies from 9 countries were identified, including 10 (56%) randomized controlled trials (RCTs), 3 (17%) cluster RCTs, and 5 (28%) non-RCT studies. The number of participants ranged from 76 to 1562. The overall mean age range was 41-67 years, and the proportion of female participants ranged from 0% to 100%. Most (n = 17, 94%) studies used non-physician personnel to implement the proposed interventions. Fourteen studies (78%) implemented multilevel combinations of interventions. Education and training, team-based care, consultation, and Short Message Service reminders were the most common interventions tested. CONCLUSIONS This review presents the most comprehensive findings on retention in hypertension care to date and fills the gaps in the literature, including the effectiveness of interventions, their components, and contextual factors. Adaptation of and implementing HIV care models, such differentiated service delivery, may be more effective and merit further study. REGISTRATION CRD42021291368. PROTOCOL REGISTRATION PROSPERO 2021 CRD42021291368. Available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291368.
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Affiliation(s)
- Jiancheng Ye
- Weill Cornell Medicine, NY, New York, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Olutobi A Sanuade
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Theresa L Walunas
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | | | - Abigail S Baldridge
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria; University of Abuja, Abuja, Nigeria
| | - Mark D Huffman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Washington University in St. Louis, St. Louis, MO, USA; The George Institute for Global Health, Sydney, Australia
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11
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Bera OP, Mondal H, Bhattacharya S. Empowering Communities: A Review of Community-Based Outreach Programs in Controlling Hypertension in India. Cureus 2023; 15:e50722. [PMID: 38234936 PMCID: PMC10793189 DOI: 10.7759/cureus.50722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
India's epidemiological shift from communicable to non-communicable diseases (NCDs) signifies the impact of healthcare advancements and changing lifestyles. Despite declines in infectious diseases, challenges related to chronic conditions such as cardiovascular diseases and diabetes have risen. Approximately one in four Indian adults has hypertension, with only 12% maintaining controlled blood pressure. To meet the 25% relative reduction target in hypertension prevalence by 2025, India must enhance treatment access and public health initiatives. A global report underscores the urgency of preventing, detecting, and managing hypertension, especially in low- and middle-income countries like India, where 188.3 million adults are estimated to have hypertension. Loss to follow-up persists in both communicable and non-communicable diseases, driven by factors such as stigma and socioeconomic barriers. Community outreach programs have proven effective, incorporating mobile health interventions, community health worker engagement, and door-to-door screenings. Hypertension management faces similar challenges, with community outreach tailored to lifestyle factors and cultural beliefs showing promise. The comprehensive strategy to control hypertension involves strengthening primary healthcare centers, promoting wellness centers, and capacitating Community Health Officers. While community-led, tech-enabled private sector interventions can screen and manage NCDs, integration with the public health system is crucial for widespread adoption and cost-effectiveness. In conclusion, tailored strategies, such as community outreach integrated into healthcare systems, are essential to address loss to follow-up and enhance health management success in both communicable and non-communicable diseases.
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Affiliation(s)
- Om Prakash Bera
- Health Systems Strengthening Unit, Global Health Advocacy Incubator, Washington, DC, USA
| | - Himel Mondal
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | - Sudip Bhattacharya
- Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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12
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Chebrolu P, Chalem A, Ponticiello M, Broderick K, Vaidyanathan A, Lorenc R, Kulkarni V, Onawale A, Mathad JS, Sundararajan R. A community health worker-led program to improve access to gestational diabetes screening in urban slums of Pune, India: Results from a mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001622. [PMID: 37889879 PMCID: PMC10610081 DOI: 10.1371/journal.pgph.0001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023]
Abstract
The World Health Organization recommends all pregnant women receive screening for gestational diabetes (GDM) with a fasting oral glucose tolerance test (OGTT). However, very few women receive recommended screening in resource-limited countries like India. We implemented a community health worker (CHW)-delivered program to evaluate if home-based, CHW-delivered OGTT would increase GDM screening in a low-resource setting. We conducted a mixed methods study in two urban slum communities in Pune, India. CHWs were trained to deliver home-based, point-of-care fasting OGTT to women in their third trimester of pregnancy. The primary outcome was uptake of CHW-delivered OGTT. Secondary outcomes included GDM prevalence and linkage to GDM care. Individual interviews were conducted with purposively sampled pregnant women, CHWs, and local clinicians to assess barriers and facilitators of this approach. From October 2021-June 2022, 248 eligible pregnant women were identified. Of these, 223 (90%) accepted CHW-delivered OGTT and 31 (14%) were diagnosed with GDM. Thirty (97%) women diagnosed with GDM subsequently sought GDM care; only 10 (33%) received lifestyle counseling or pharmacologic therapy. Qualitative interviews indicated that CHW-delivered testing was considered highly acceptable as home-based testing saved time and was more convenient than clinic-based testing. Inconsistent clinical management of GDM was attributed to providers' lack of time to deliver counseling, and perceptions that low-income populations are not at risk for GDM. Convenience and trust in a CHW-delivered GDM screening program resulted in high access to gold-standard OGTT screening and identification of a high GDM prevalence among pregnant women in two urban slum communities. Appropriate linkage to care was limited by clinician time constraints and misperceptions of GDM risk. CHW-delivered GDM screening and counseling may improve health education and access to preventive healthcare, offloading busy public clinics in high-need, low-resource settings.
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Affiliation(s)
- Puja Chebrolu
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Andrea Chalem
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Matthew Ponticiello
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Kathryn Broderick
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Arthi Vaidyanathan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Rachel Lorenc
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | | | | | - Jyoti S. Mathad
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
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13
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Naanyu V, Njuguna B, Koros H, Andesia J, Kamano J, Mercer T, Bloomfield G, Pastakia S, Vedanthan R, Akwanalo C. Community engagement to inform development of strategies to improve referral for hypertension: perspectives of patients, providers and local community members in western Kenya. BMC Health Serv Res 2023; 23:854. [PMID: 37568172 PMCID: PMC10422762 DOI: 10.1186/s12913-023-09847-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Hypertension is the leading cause of death and disability. Clinical care for patients with hypertension in Kenya leverages referral networks to provide basic and specialized healthcare services. However, referrals are characterized by non-adherence and delays in completion. An integrated health information technology (HIT) and peer-based support strategy to improve adherence to referrals and blood pressure control was proposed. A formative assessment gathered perspectives on barriers to referral completion and garnered thoughts on the proposed intervention. METHODS We conducted a qualitative study in Kitale, Webuye, Kocholya, Turbo, Mosoriot and Burnt Forest areas of Western Kenya. We utilized the PRECEDE-PROCEED framework to understand the behavioral, environmental and ecological factors that would influence uptake and success of our intervention. We conducted four mabaraza (customary heterogenous community assemblies), eighteen key informant interviews, and twelve focus group discussions among clinicians, patients and community members. The data obtained was audio recorded alongside field note taking. Audio recordings were transcribed and translated for onward coding and thematic analysis using NVivo 12. RESULTS Specific supply-side and demand-side barriers influenced completion of referral for hypertension. Key demand-side barriers included lack of money for care and inadequate referral knowledge. On the supply-side, long distance to health facilities, low availability of services, unaffordable services, and poor referral management were reported. All participants felt that the proposed strategies could improve delivery of care and expressed much enthusiasm for them. Participants appreciated benefits of the peer component, saying it would motivate positive patient behavior, and provide health education, psychosocial support, and assistance in navigating care. The HIT component was seen as reducing paper work, easing communication between providers, and facilitating tracking of patient information. Participants also shared concerns that could influence implementation of the two strategies including consent, confidentiality, and reduction in patient-provider interaction. CONCLUSIONS Appreciation of local realities and patients' experiences is critical to development and implementation of sustainable strategies to improve effectiveness of hypertension referral networks. Incorporating concerns from patients, health care workers, and local leaders facilitates adaptation of interventions to respond to real needs. This approach is ethical and also allows research teams to harness benefits of participatory community-involved research. TRIAL REGISTRATION Clinicaltrials.gov, NCT03543787, Registered June 1, 2018. https://clinicaltrials.gov/ct2/show/NCT03543787.
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Affiliation(s)
- Violet Naanyu
- Department of Sociology Psychology and Anthropology, School of Arts and Social Sciences, Moi University, Nairobi, Kenya.
| | - Benson Njuguna
- Department of Clinical Pharmacy & Practice, Moi Teaching and Referral Hospital, Nairobi, Kenya
| | - Hillary Koros
- Academic Model Providing Access to Healthcare (AMPATH), Nairobi, Kenya
| | - Josephine Andesia
- Academic Model Providing Access to Healthcare (AMPATH), Nairobi, Kenya
| | - Jemima Kamano
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Nairobi, Kenya
| | - Tim Mercer
- Department of Population Health & Department of Medicine, University of Texas at Austin, Austin, USA
| | - Gerald Bloomfield
- Department of Medicine, Duke University School of Medicine &, Duke Global Health Institute, Durham, USA
| | - Sonak Pastakia
- Department of Pharmacy Practice & Center for Health Equity & Innovation, Purdue University College of Pharmacy, West Lafayette, USA
| | - Rajesh Vedanthan
- Department of Population Health & Department of Medicine, New York University Grossman School of Medicine, New York, USA
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14
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Okpechi IG, Chukwuonye II, Ekrikpo U, Noubiap JJ, Raji YR, Adeshina Y, Ajayi S, Barday Z, Chetty M, Davidson B, Effa E, Fagbemi S, George C, Kengne AP, Jones ESW, Liman H, Makusidi M, Muhammad H, Mbah I, Ndlovu K, Ngaruiya G, Okwuonu C, Samuel-Okpechi U, Tannor EK, Ulasi I, Umar Z, Wearne N, Bello AK. Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review. BMC Health Serv Res 2023; 23:446. [PMID: 37147670 PMCID: PMC10163711 DOI: 10.1186/s12913-023-09416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 04/18/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations. METHODS We conducted this scoping review to answer the question: "what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?" Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively. RESULTS Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively. CONCLUSION Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined.
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Affiliation(s)
- Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Canada.
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
| | - Ijezie I Chukwuonye
- Department of Internal Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Udeme Ekrikpo
- Division of Nephrology, University of Uyo, Akwa Ibo State, Uyo, Nigeria
| | - Jean Jacques Noubiap
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Yemi R Raji
- Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Yusuf Adeshina
- Division of Nephrology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Samuel Ajayi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Zunaid Barday
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Malini Chetty
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Bianca Davidson
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Emmanuel Effa
- Department of Medicine, University of Calabar, Calabar, Nigeria
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Stephen Fagbemi
- Department of Epidemiology, Ondo State Ministry of Health, Ondo, Nigeria
| | - Cindy George
- Non-Communicable Disease Research Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Disease Research Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Erika S W Jones
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Hamidu Liman
- Division of Nephrology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Mohammad Makusidi
- Division of Nephrology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Hadiza Muhammad
- Division of Nephrology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ikechukwu Mbah
- Dept of Medicine College of Med and Health Sciences, Bingham University, Jos, Nigeria
| | - Kwazi Ndlovu
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | | | - Chimezie Okwuonu
- Department of Internal Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | | | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ifeoma Ulasi
- Department of Medicine, University of Nigeria, Ituku Ozalla, Enugu State, Nigeria
| | - Zulkifilu Umar
- Department of Epidemiology, Ondo State Ministry of Health, Ondo, Nigeria
| | - Nicola Wearne
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Canada
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15
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Schutte AE, Jafar TH, Poulter NR, Damasceno A, Khan NA, Nilsson PM, Alsaid J, Neupane D, Kario K, Beheiry H, Brouwers S, Burger D, Charchar FJ, Cho MC, Guzik TJ, Haji Al-Saedi GF, Ishaq M, Itoh H, Jones ESW, Khan T, Kokubo Y, Kotruchin P, Muxfeldt E, Odili A, Patil M, Ralapanawa U, Romero CA, Schlaich MP, Shehab A, Mooi CS, Steckelings UM, Stergiou G, Touyz RM, Unger T, Wainford RD, Wang JG, Williams B, Wynne BM, Tomaszewski M. Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension. Cardiovasc Res 2023; 119:381-409. [PMID: 36219457 PMCID: PMC9619669 DOI: 10.1093/cvr/cvac130] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.
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Affiliation(s)
- Aletta E Schutte
- School of Population Health, University of New South Wales, Kensington Campus, High Street, Sydney 2052 NSW, Australia; The George Institute for Global Health, King Street, Newton, Sydney NSW 2052, Australia
- Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease; North-West University, Hoffman Street, Potchefstroom 2520, South Africa
- SAMRC Development Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2000, South Africa
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Department of Renal Medicine, 8 College Rd., Singapore 169857, Singapore
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London W12 7RH, UK
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Peter M Nilsson
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden
| | - Jafar Alsaid
- Ochsner Health System, New Orleans, Louisiana, USA
- Queensland University, Brisbane, Queensland, Australia
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hind Beheiry
- International University of Africa, Khartoum, Sudan
| | - Sofie Brouwers
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Aalst, Belgium
- Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dylan Burger
- Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fadi J Charchar
- Health Innovation and Transformation Centre, Federation University, Ballarat, Victoria, Australia
- Department of Physiology and Anatomy, University of Melbourne, Melbourne, Victoria, Australia
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8585, Japan
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Taskeen Khan
- Department of Public Health Medicine, University of Pretoria, Pretoria, South Africa
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Elizabeth Muxfeldt
- University Hospital Clementino Fraga Filho, Hypertension Program, Universidade Federal do Rio de Janeiro, Brazil
| | - Augustine Odili
- Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Mansi Patil
- Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad, India
| | - Udaya Ralapanawa
- Faculty of Medicine, University of Peradeniya, Kandy, Central Province, Sri Lanka
| | - Cesar A Romero
- Renal Division, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Perth, Western Australia, Australia
| | - Abdulla Shehab
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ching Siew Mooi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - U Muscha Steckelings
- Department of Cardiovascular & Renal Research, Institute of Molecular Medicine. University of Southern Denmark, Odense, Denmark
| | - George Stergiou
- Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rhian M Touyz
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Thomas Unger
- CARIM - Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Richard D Wainford
- Department of Pharmacology & Experimental Therapeutics and the Whitaker, Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London (UCL), National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
| | - Brandi M Wynne
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
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16
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Kate MP, Samuel C, Singh S, Jain M, Kamra D, Singh GB, Sharma M, Pandian JD. Community health volunteer for blood pressure control in rural people with stroke in India: Pilot randomised trial. J Stroke Cerebrovasc Dis 2023; 32:107107. [PMID: 37003249 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/16/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE To test the hypothesis that an Accredited social health activist (ASHA), a community health volunteer in a task-sharing model can help in sustained control of systolic blood pressure (BP) in rural people with Stroke and hypertension at 6 months follow up. METHODS In this randomized trial two rural areas (Pakhowal and Sidhwan bet) with 70 and 94 villages respectively were screened for people with stroke and hypertension. They were assigned to either ASHA-assisted BP control in addition to standard-of-care (Pakhowal-intervention Group) or standard-of-care alone (Sidhwan bet- Control Group). Assessors blinded to intervention conducted the baseline and 6 months follow-up visits to measure risk factors in both the rural areas. RESULTS A total of 140 people with stroke with mean age of 63.7 ± 11.5 years and 44.3% females were randomised. The baseline systolic BP was higher in the intervention group (n = 65,173.5 ± 22.9 mmHg) compared to the control group (n = 75,163 ± 18.7 mmHg, p = 0.004). The follow-up systolic BP was lower in the intervention group compared to the control group 145 ± 17.2 mmHg and 166.6 ± 25.7 mmHg respectively (p < 0.0001). According to the intention-to-treat analysis a total of 69.2% of patients in the intervention group achieved systolic BP control compared to 18.9% in the control group patients (OR 9, 95% CI 3.9-20.3; p < 0.0001). CONCLUSION Task sharing with ASHA a community health volunteer can improve BP control in rural people with stroke and hypertension. They can also help in the adoption of healthy behaviour. CLINICAL TRIAL REGISTRATION NUMBER ctri.nic.in, CTRI/2018/09/015709.
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Affiliation(s)
- Mahesh Pundlik Kate
- Associate Professor, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 7-132C Clinical Sciences Building, 11350 83 Avenue, Edmonton, AB T6G2E3, Canada.
| | - Clarence Samuel
- Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - Shavinder Singh
- Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - Maneeta Jain
- Senior Consultant, Healthcare Financing, National Health Systems Resource Centre, India
| | - Deepshikha Kamra
- Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - G B Singh
- State Programme Officer, National Programme for Prevention of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) Programme, Government of Punjab, Chandigarh, India
| | - Meenakshi Sharma
- Scientist-G, Program Officer: Cardiovascular Diseases and Neurology, Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Jeyaraj Durai Pandian
- Professor of Neurology and Principal, Christian Medical College, Ludhiana, India; School of Nursing, University of Central Lancashire, Preston, United Kingdom; NIHR Global Health Research Group on Improving stroke care in India, United Kingdom
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17
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Rao KD, Mehta A, Kautsar H, Kak M, Karem G, Misra M, Joshi H, Herbst CH, Perry HB. Improving quality of non-communicable disease services at primary care facilities in middle-income countries: A scoping review. Soc Sci Med 2023; 320:115679. [PMID: 36731302 DOI: 10.1016/j.socscimed.2023.115679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/02/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
Health systems in middle-income countries face important challenges in managing the high burden of Non-Communicable Diseases (NCD). Primary health care is widely recognized as key to managing NCDs in communities. However, the effectiveness of this approach is limited by poor quality of care (QoC), among others. This scoping review identifies the types of interventions that have been used in middle-income countries to improve the quality of NCD services at primary care facilities. Further, it identifies the range of outcomes these quality interventions have influenced. This scoping review covered both the grey and peer-reviewed literature. The 149 articles reviewed were classified into four domains - governance, service-delivery systems, health workforce, and patients and communities. There was a remarkable unevenness in the geographic distribution of studies - lower middle-income countries and some regions (Middle East, North Africa, and South East Asia) had a scarcity of published studies. NCDs such as stroke and cardiovascular disease, mental health, cancer, and respiratory disorders received less attention. The thrust of quality interventions was directed at the practice of NCD care by clinicians, facilities, or patients. Few studies provided evidence from interventions at the organizations or policy levels. Overall, effectiveness of quality interventions was mixed across domains. In general, positive or mixed effects on provider clinical skills and behavior, as well as, improvements in patient outcomes were found across interventions. Access to care and coverage of screening services were positively influenced by the interventions reviewed. This review shows that quality improvement interventions tried in middle-income countries mostly focused at the provider and facility level, with few focusing on the organizational and policy level. There is a need to further study the effectiveness of organizational and policy level interventions on the practice and outcomes of NCD care.
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Affiliation(s)
- Krishna D Rao
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Akriti Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Hunied Kautsar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | - Madhavi Misra
- Johns Hopkins India Private Limited, New Delhi, India
| | - Harsha Joshi
- Johns Hopkins India Private Limited, New Delhi, India
| | | | - Henry B Perry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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18
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Mogaka JN, Lagat H, Otieno G, Macharia P, Wamuti B, Masyuko S, Sharma M, Kariithi E, Farquhar C, Temu TM. Descriptive study: Feasibility of integrating hypertension screening into HIV assisted partner notification services model in Kenya. Medicine (Baltimore) 2023; 102:e33067. [PMID: 36827044 PMCID: PMC11309717 DOI: 10.1097/md.0000000000033067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Prevalence of hypertension (HTN) and human immunodeficiency virus (HIV) are high among men while screening rates are low. Assisted partner notification service is a strategy recommended by the World Health Organization that aims to increase HIV testing and treatment uptake and may present an opportunity to offer integrated HIV/HTN screening and treatment services. In this prospective cohort study, we assessed the feasibility of integrating HTN screening for male sexual partners of females newly tested HIV-positive in 10 health facilities in Kenya. Participants were notified of the exposure and offered HIV testing and HTN screening; if they accepted and tested positive for either HTN, HIV, or both, they were referred for care. HTN was defined as systolic blood pressure ≥ 140 mm Hg, diastolic blood pressure ≥ 90, or the use of antihypertensive medication. Among 1313 male partners traced, 99% accepted HIV testing and HTN screening. Overall, 4% were found to have HTN, 29% were in the pre-HTN stage, and 9% were HIV-positive. Only 75% had previously been screened for HTN compared to 95% who had previously tested for HIV. A majority preferred non-facility-based screening. The participants who refused HTN screening noted time constraints as a significant hindrance. HIV and HTN screening uptake was high in this hard-to-reach population of men aged 25 to 50. Although HTN rates were low, an integrated approach provided an opportunity to detect those with pre-HTN and intervene early. Strategic integration of HTN services within assisted partners services may promote and normalize testing by offering inclusive and accessible services to men.
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Affiliation(s)
| | | | | | - Paul Macharia
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Sarah Masyuko
- Ministry of Health-National AIDS and STI Control Program, Nairobi, Kenya
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, WA
- Department of Epidemiology and Medicine, University of Washington, Seattle, WA
| | - Tecla M. Temu
- Department of Global Health, University of Washington, Seattle, WA
- Institute of Tropical Diseases, University of Nairobi, Nairobi, Kenya
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19
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Hickey MD, Owaraganise A, Sang N, Opel FJ, Mugoma EW, Ayieko J, Kabami J, Chamie G, Kakande E, Petersen ML, Balzer LB, Kamya MR, Havlir DV. Effect of a one-time financial incentive on linkage to chronic hypertension care in Kenya and Uganda: A randomized controlled trial. PLoS One 2022; 17:e0277312. [PMID: 36342940 PMCID: PMC9639834 DOI: 10.1371/journal.pone.0277312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Abstract
Background Fewer than 10% of people with hypertension in sub-Saharan Africa are diagnosed, linked to care, and achieve hypertension control. We hypothesized that a one-time financial incentive and phone call reminder for missed appointments would increase linkage to hypertension care following community-based screening in rural Uganda and Kenya. Methods In a randomized controlled trial, we conducted community-based hypertension screening and enrolled adults ≥25 years with blood pressure ≥140/90 mmHg on three measures; we excluded participants with known hypertension or hypertensive emergency. The intervention was transportation reimbursement upon linkage (~$5 USD) and up to three reminder phone calls for those not linking within seven days. Control participants received a clinic referral only. Outcomes were linkage to hypertension care within 30 days (primary) and hypertension control <140/90 mmHg measured in all participants at 90 days (secondary). We used targeted minimum loss-based estimation to compute adjusted risk ratios (aRR). Results We screened 1,998 participants, identifying 370 (18.5%) with uncontrolled hypertension and enrolling 199 (100 control, 99 intervention). Reasons for non-enrollment included prior hypertension diagnosis (n = 108) and hypertensive emergency (n = 32). Participants were 60% female, median age 56 (range 27–99); 10% were HIV-positive and 42% had baseline blood pressure ≥160/100 mmHg. Linkage to care within 30 days was 96% in intervention and 66% in control (aRR 1.45, 95%CI 1.25–1.68). Hypertension control at 90 days was 51% intervention and 41% control (aRR 1.22, 95%CI 0.92–1.66). Conclusion A one-time financial incentive and reminder call for missed visits resulted in a 30% absolute increase in linkage to hypertension care following community-based screening. Financial incentives can improve the critical step of linkage to care for people newly diagnosed with hypertension in the community.
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Affiliation(s)
- Matthew D. Hickey
- Division of HIV, Infectious Disease, & Global Medicine, University of California, San Francisco, CA, United States of America
- * E-mail:
| | | | - Norton Sang
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - James Ayieko
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Gabriel Chamie
- Division of HIV, Infectious Disease, & Global Medicine, University of California, San Francisco, CA, United States of America
| | - Elijah Kakande
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Maya L. Petersen
- School of Public Health, University of California, Berkeley, CA, United States of America
| | - Laura B. Balzer
- School of Public Health, University of California, Berkeley, CA, United States of America
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- School of Medicine, Makerere University, Kampala, Uganda
| | - Diane V. Havlir
- Division of HIV, Infectious Disease, & Global Medicine, University of California, San Francisco, CA, United States of America
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20
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Tran DN, Kangogo K, Amisi JA, Kamadi J, Karwa R, Kiragu B, Laktabai J, Manji IN, Njuguna B, Szkwarko D, Qian K, Vedanthan R, Pastakia SD. Community-based medication delivery program for antihypertensive medications improves adherence and reduces blood pressure. PLoS One 2022; 17:e0273655. [PMID: 36084087 PMCID: PMC9462824 DOI: 10.1371/journal.pone.0273655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/14/2022] [Indexed: 11/18/2022] Open
Abstract
Non-adherence to antihypertensive medications is a major cause of uncontrolled hypertension, leading to cardiovascular morbidity and mortality. Ensuring consistent medication possession is crucial in addressing non-adherence. Community-based medication delivery is a strategy that may improve medication possession, adherence, and blood pressure (BP) reduction. Our program in Kenya piloted a community medication delivery program, coupled with blood pressure monitoring and adherence evaluation. Between September 2019 and March 2020, patients who received hypertension care from our chronic disease management program also received community-based delivery of antihypertensive medications. We calculated number of days during which each patient had possession of medications and analyzed the relationship between successful medication delivery and self-reported medication adherence and BP. A total of 128 patient records (80.5% female) were reviewed. At baseline, mean systolic blood pressure (SBP) was 155.7 mmHg and mean self-reported adherence score was 2.7. Sixty-eight (53.1%) patients received at least 1 successful medication delivery. Our pharmacy dispensing records demonstrated that medication possession was greater among patients receiving medication deliveries. Change in self-reported medication adherence from baseline worsened in patients who did not receive any medication delivery (+0.5), but improved in patients receiving 1 delivery (-0.3) and 2 or more deliveries (-0.8). There was an SBP reduction of 1.9, 6.1, and 15.5 mmHg among patients who did not receive any deliveries, those who received 1 delivery, and those who received 2 or more medication deliveries, respectively. Adjusted mixed-effect model estimates revealed that mean SBP reduction and self-reported medication adherence were improved among individuals who successfully received medication deliveries, compared to those who did not. A community medication delivery program in western Kenya was shown to be implementable and enhanced medication possession, reduced SBP, and significantly improved self-reported adherence. This is a promising strategy to improve health outcomes for patients with uncontrolled hypertension that warrants further investigation.
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Affiliation(s)
- Dan N. Tran
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, Pennsylvania, United States of America
| | - Kibet Kangogo
- The Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - James A. Amisi
- Department of Family Medicine, Medical Education and Community Health, Moi University School of Medicine, Eldoret, Kenya
| | - James Kamadi
- The Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Rakhi Karwa
- Department of Pharmacy Practice, Purdue University School of Pharmacy, Indianapolis, Indiana, United States of America
| | - Benson Kiragu
- The Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jeremiah Laktabai
- Department of Family Medicine, Medical Education and Community Health, Moi University School of Medicine, Eldoret, Kenya
| | - Imran N. Manji
- Department of Clinical Pharmacy and Practice, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Benson Njuguna
- Department of Clinical Pharmacy and Practice, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Daria Szkwarko
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Kun Qian
- Department of Population Health, NYU Grossman School of Medicine, New York, United States of America
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, United States of America
| | - Sonak D. Pastakia
- Department of Pharmacy Practice, Purdue University School of Pharmacy, Indianapolis, Indiana, United States of America
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21
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Ye J, Orji IA, Baldridge AS, Ojo TM, Shedul G, Ugwuneji EN, Egenti NB, Aluka-Omitiran K, Okoli RCB, Eze H, Nwankwo A, Hirschhorn LR, Chopra A, Ale BM, Shedul GL, Tripathi P, Kandula NR, Huffman MD, Ojji DB. Characteristics and Patterns of Retention in Hypertension Care in Primary Care Settings From the Hypertension Treatment in Nigeria Program. JAMA Netw Open 2022; 5:e2230025. [PMID: 36066896 PMCID: PMC9449788 DOI: 10.1001/jamanetworkopen.2022.30025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND More than 1.2 billion adults worldwide have hypertension. High retention in clinical care is essential for long-term management of hypertension, but 1-year retention rates are less than 50% in many resource-limited settings. OBJECTIVE To evaluate short-term retention rates and associated factors among patients with hypertension in primary health care centers in the Federal Capital Territory of Nigeria. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, data were collected by trained study staff from adults aged 18 years or older at 60 public, primary health care centers in Nigeria between January 2020 and July 2021 as part of the Hypertension Treatment in Nigeria (HTN) Program. Patients with hypertension were registered. EXPOSURES Follow-up visit for hypertension care within 37 days of the registration visit. MAIN OUTCOMES AND MEASURES The main outcome was the 3-month rolling average 37-day retention rate in hypertension care, calculated by dividing the number of patients who had a follow-up visit within 37 days of their first (ie, registration) visit in the program by the total number of registered patients with hypertension during multiple consecutive 3-month periods. Interrupted time series analyses evaluated trends in retention rates before and after the intervention phase of the HTN Program. Mixed-effects, multivariable regression models evaluated associations between patient-, site-, and area council-level factors, hypertension treatment and control status, and 37-day retention rate. RESULTS In total, 10 686 patients (68.3% female; mean [SD] age, 48.8 [12.7] years) were included in the analysis. During the study period, the 3-month rolling average 37-day retention rate was 41% (95% CI, 37%-46%), with wide variability among sites. The retention rate was higher among patients who were older (adjusted odds ratio [aOR], 1.01 per year; 95% CI, 1.01-1.02 per year), were female (aOR, 1.11; 95% CI, 1.01-1.23), had a higher body mass index (aOR, 1.01; 95% CI, 1.00-1.02), were in the Kuje vs the Abaji area council (aOR, 2.25; 95% CI, 1.25-4.04), received hypertension treatment at the registration visit (aOR, 1.27; 95% CI, 1.07-1.50), and were registered during the postintervention period (aOR, 1.16; 95% CI, 1.06-1.26). CONCLUSIONS AND RELEVANCE The findings suggest that retention in hypertension care is suboptimal in primary health care centers in Nigeria, although large variability among sites was found. Potentially modifiable and nonmodifiable factors associated with retention were identified and may inform multilevel, contextualized implementation strategies to improve retention.
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Affiliation(s)
- Jiancheng Ye
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ikechukwu A. Orji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Tunde M. Ojo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Grace Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Eugenia N. Ugwuneji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Nonye B. Egenti
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | | | - Helen Eze
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Ada Nwankwo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Aashima Chopra
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Boni M. Ale
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Holo Healthcare, Nairobi, Kenya
| | - Gabriel L. Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Priya Tripathi
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Mark D. Huffman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Washington University in St Louis, St Louis, Missouri
| | - Dike B. Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- University of Abuja, Abuja, Nigeria
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22
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Ogungbe O, Cazabon D, Ajenikoko A, Jeemon P, Moran AE, Commodore-Mensah Y. Determining the frequency and level of task-sharing for hypertension management in LMICs: A systematic review and meta-analysis. EClinicalMedicine 2022; 47:101388. [PMID: 35480075 PMCID: PMC9035722 DOI: 10.1016/j.eclinm.2022.101388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) bear a disproportionately higher burden of Cardiovascular Disease (CVD). Team-based care approach adds capacity to improve blood pressure (BP) control. This updated review aimed to test team-based care efficacy at different levels of hypertension team-based care complexity. METHODS We searched PubMed, Embase, Cochrane, and CINAHL for newer articles on task-sharing interventions to manage hypertension in LMICs. Levels of tasks complexity performed by healthcare workers added to the clinical team in hypertension control programs were categorized as administrative tasks (level 1), basic clinical tasks (level 2), and/or advanced clinical tasks (level 3). Meta-analysis using an inverse variance weighted random-effects model summarized trial-based evidence on the efficacy of team-based care on BP control, compared with usual care. FINDINGS Forty-three RCT articles were included in the meta-analysis: 31 studies from the previous systematic review, 12 articles from the updated search. The pooled mean effect for team-based care was a -4.6 mm Hg (95% CI: -5.8, -3.4, I2 = 80.2%) decrease in systolic BP compared with usual care. We found similar comparative reduction among different levels of team-based care complexity, i.e., administrative and basic clinical tasks (-4.7 mm Hg, 95% CI: -6.8, -2.2; I2 = 79.8%); and advanced clinical tasks (-4.5 mmHg, 95%CI: -6.1, -3.3; I2 = 81%). Systolic BP was reduced most by team-based care involving pharmacists (-7.3 mm Hg, 95% CI: -9.2, -5.4; I2 = 67.2%); followed by nurses (-5.1 mm Hg, 95% CI: -8.0, -2.2; I2 = 72.7%), dieticians (-4.7 mmHg, 95%CI: -7.1, -2.3; I2 = 0.0%), then community health workers (-3.3 mm Hg, 95% CI: -4.8, -1.8; I2 = 77.3%). INTERPRETATION Overall, team-based hypertension care interventions consistently contributed to lower systolic BP compared to usual care; the effect size varies by the clinical training of the healthcare team members. FUNDING Resolve To Save Lives (RTSL) Vital Strategies, Danielle Cazabon, Andrew E. Moran, Yvonne Commodore-Mensah receive salary support from Resolve to Save Lives, an initiative of Vital Strategies. Resolve to Save Lives is jointly supported by grants from Bloomberg Philanthropies, the Bill & Melinda Gates Foundation, and Gates Philanthropy Partners, which is funded with support from the Chan Zuckerberg Foundation.
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Affiliation(s)
| | - Danielle Cazabon
- Resolve to Save Lives, an initiative of Vital Strategies, New York, NY, USA
| | - Adefunke Ajenikoko
- Resolve to Save Lives, an initiative of Vital Strategies, New York, NY, USA
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Andrew E. Moran
- Resolve to Save Lives, an initiative of Vital Strategies, New York, NY, USA
- Columbia University Irving Medical Center, Columbia University, New York, New York
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Corresponding author. Yvonne Commodore-Mensah, PhD, MHS, RN, Johns Hopkins University School of Nursing, 525 N. Wolfe St. Baltimore, MD. 21205 United States
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23
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Stokes K, Oronti B, Cappuccio FP, Pecchia L. Use of technology to prevent, detect, manage and control hypertension in sub-Saharan Africa: a systematic review. BMJ Open 2022; 12:e058840. [PMID: 35383086 PMCID: PMC8984054 DOI: 10.1136/bmjopen-2021-058840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To identify and assess the use of technologies, including mobile health technology, internet of things (IoT) devices and artificial intelligence (AI) in hypertension healthcare in sub-Saharan Africa (SSA). DESIGN Systematic review. DATA SOURCES Medline, Embase, Scopus and Web of Science. ELIGIBILITY CRITERIA Studies addressing outcomes related to the use of technologies for hypertension healthcare (all points in the healthcare cascade) in SSA. METHODS Databases were searched from inception to 2 August 2021. Screening, data extraction and risk of bias assessment were done in duplicate. Data were extracted on study design, setting, technology(s) employed and outcomes. Blood pressure (BP) reduction due to intervention was extracted from a subset of randomised controlled trials. Methodological quality was assessed using the Mixed Methods Appraisal Tool. RESULTS 1717 hits were retrieved, 1206 deduplicated studies were screened and 67 full texts were assessed for eligibility. 22 studies were included, all reported on clinical investigations. Two studies were observational, and 20 evaluated technology-based interventions. Outcomes included BP reduction/control, treatment adherence, retention in care, awareness/knowledge of hypertension and completeness of medical records. All studies used mobile technology, three linked with IoT devices. Short Message Service (SMS) was the most popular method of targeting patients (n=6). Moderate BP reduction was achieved in three randomised controlled trials. Patients and healthcare providers reported positive perceptions towards the technologies. No studies using AI were identified. CONCLUSIONS There are a range of successful applications of key enabling technologies in SSA, including BP reduction, increased health knowledge and treatment adherence following targeted mobile technology interventions. There is evidence to support use of mobile technology for hypertension management in SSA. However, current application of technologies is highly heterogeneous and key barriers exist, limiting efficacy and uptake in SSA. More research is needed, addressing objective measures such as BP reduction in robust randomised studies. PROSPERO REGISTRATION NUMBER CRD42020223043.
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Affiliation(s)
- Katy Stokes
- School of Engineering, University of Warwick, Coventry, UK
| | - Busola Oronti
- School of Engineering, University of Warwick, Coventry, UK
| | - Francesco P Cappuccio
- Division of Health Sciences, University of Warwick, Warwick Medical School, Coventry, UK
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Mbuthia GW, Magutah K, Pellowski J. Approaches and outcomes of community health worker's interventions for hypertension management and control in low-income and middle-income countries: systematic review. BMJ Open 2022; 12:e053455. [PMID: 35365519 PMCID: PMC8977767 DOI: 10.1136/bmjopen-2021-053455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To critically appraise the scope, content and outcomes of community health worker (CHW) interventions designed to reduce blood pressure (BP) in low-income and middle-income countries (LMICs). METHOD We performed a database search (PUBMED, EMBASE, CINAHL, PsycINFO, OpenGrey, Cochrane Central Trials Register and Cochrane Database of Systematic Reviews) to identify studies in LMICs from 2000 to 2020. Eligible studies were interventional studies published in English and reporting CHW interventions for management of BP in LMICs. Two independent reviewers screened the titles, abstracts and full texts of publications for eligibility and inclusion. Relevant information was extracted from these studies using a tailored template. Risk of bias was assessed using the Cochrane collaboration risk of bias tool. Qualitative synthesis of results was done through general summary of the characteristics and findings of each study. We also analysed the patterns of interventions and their outcomes across the studies. Results were presented in form of narrative and tables. RESULTS Of the 1557 articles identified, 14 met the predefined criteria. Of these, 12 were cluster randomised trials whereas two were pretest/post-test studies. The CHW interventions were mainly community-based and focused on behaviour change for promoting BP control among hypertensive patients as well as healthy individuals. The interventions had positive effects in the BP reduction, linkage to care, treatment adherence and in reducing cardivascular-disease risk level. DISCUSSION AND CONCLUSION The current review is limited in that, a meta-analysis to show the overall effect of CHW interventions in the management of hypertension was not possible due to the diversity of the interventions, and outcomes of the studies included in the review. Summarised outcomes of individual studies showed CHW enhanced the control and management of hypertension. Further studies are needed to indicate the impact and cost-effectiveness of CHW-led interventions in the control and management of hypertension in LMICs.
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Affiliation(s)
- Grace Wambura Mbuthia
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Karani Magutah
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Jennifer Pellowski
- International Health Institute, School of Public Health, Brown University, Providence, Rhode Island, USA
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Abid L, Hammami R, Chamtouri I, Drissa M, Boudiche S, Bahloul M, BenSlima H, Sayahi K, Charfeddine S, Allouche E, Rais L, Kaab B, IbnHadjamor H, BenFatma L, Garbaa R, Boukhris S, Halima MB, Amdouni N, Ghorbel C, Soudani S, Khaled I, Triki S, Bouazizi F, Jemai I, Abdeljalil O, Ammar Y, Farah A, Neji A, Oumayma Z, Seghaier S, Mokrani S, Thawaba H, Sarray H, Ouaghlani K, Thabet H, Mnif Z, Boujelban F, Sghaier M, Khalifa R, Fourati S, Kammoun Y, Abid S, Hamza C, Jeddou SB, Sabbah L, Lakhdhar R, Dammak N, Sellami T, Herbegue B, Koubaa A, Triki F, Ellouz T, Hmoudi A, BenAmeur I, Boukhchina M, Abid N, Wachtati W, Nasrallah N, Houidi Y, Meghaieth F, Ghodhbane E, Chayeb M, Chenik S, Kaabachi S, Saadaoui N, BenAmeur I, Affes M, Ouali S, Chaker M, Naanaa H, Dghim M, Jarrar M, Mnif J, Turki A, Zairi I, Langar J, Dardouri S, Hchaichi I, Chettaoui R, Essmat W, Chakroun A, Mzoughi K, Mechmeche R, BenHalima A, BenKhala S, Chtourou S, Maalej A, Ayari M, Hadrich M, Tlili R, Azaiez F, Bouhlel I, Sahnoun S, Jerbi H, BenMrad I, Riahi L, Sahnoun M, BenJemaa A, BenSalem A, Rekik B, BenDoudou M, Boujneh R, Joulak A, Mejdoub Y, Gtif I, Jribi G, Naffeti E, Gamra H, BenYousef S, Sdiri W, BenHalima N, BenAmeur Y, Kachboura S, Kraiem S, Fehri W, Bazdeh L, Mourali M, Milouchi S, Drissa H, Maatouk F, Zakhama L, Addad F, Kammoun S, Abdesselem S. Epidemiologic features and management of hypertension in Tunisia, the results from the Hypertension National Registry (NaTuRe HTN). BMC Cardiovasc Disord 2022; 22:131. [PMID: 35351007 PMCID: PMC8966189 DOI: 10.1186/s12872-022-02584-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertension is the leading cause of morbi-mortality in our country. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. METHODS Nature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. Blood pressure measurements were conducted during consultation, using a standardized auscultatory or oscillometric sphygmomanometer after at least 15 min of rest. The diagnosis of new hypertension is based on the 2018 ESC/ESH criteria. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. RESULTS Three hundred twenty-one investigators participated in the study. We enrolled 25,890 patients with a female predominance (Sex ratio, 1.21) and an average age of 64.4 ± 12.2 years. Most individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as a BP target, and only in 18.6% if we consider 130/80 as a target. The independent predictors of uncontrolled blood pressure were male sex (OR = 1.09, 95%CI [1.02-1.16]), age > 65 year-old (OR = 1.07, 95% CI[1.01-1.13], diabetes (OR = 1.18, 95% CI [1.11-1.25], Smoking (OR = 1.15, 95% CI [1.05-1.25]), Obesity (OR = 1.14, 95% CI[1.07-1.21]), management in public sector (OR = 1.25, 95% CI [1.16-1.34]), and Heart rate > 80 bpm (OR = 1.59, 95% CI [1.48-1.71]). Contrarily, high educational level (OR = 0.9, 95% CI [0.84-0.97], absence of history of coronary disease (OR = 0.86, 95% CI [0.8-0.93]), salt restriction (OR = 0.48, 95% CI [0.45-0.51]), drug compliance (OR = 0.57, 95% CI[0.52-0.61]), and regular physical activity (OR = 0.77, 95% CI[0.71-0.84]) are strong predictors of blood pressure control. CONCLUSION NaTuRe HTN showed that blood pressure control was reached in more than half of the Tunisian people. The control remains low in patients with high cardiovascular profiles and in those treated in the public sector. A national health program based on therapeutic education, regular control and continuous support to the public institutions is needed to decrease the burden of hypertension incidence rate.
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Affiliation(s)
- Leila Abid
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia.
| | - Rania Hammami
- Cardiology Department, Hedi Chaker-Sfax University Hospital, Sfax, Tunisia
| | - Ikram Chamtouri
- Cardiology Department B, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Meriam Drissa
- Cardiology Department, La Rabta 2 (Pr Drissa) University Hospital, Tunis, Tunisia
| | - Selim Boudiche
- Cardiology Department, La Rabta 1 (Pr Mourali) University Hospital, Tunis, Tunisia
| | | | - Hedi BenSlima
- Cardiology Department, Hospital of Menzel Bourguiba, Bizerte, Tunisia
| | - Khaled Sayahi
- Cardiology Department, ElKef Hospital, Elkef, Tunisia
| | - Selma Charfeddine
- Cardiology Department, Hedi Chaker-Sfax University Hospital, Sfax, Tunisia
| | - Emna Allouche
- Cardiology Department, Charles Nicole University Hospital, Tunis, Tunisia
| | - Lamia Rais
- Nephrology Department, La Rabta University Hospital, Tunis, Tunisia
| | - Badr Kaab
- Nephrology Department, La Rabta University Hospital, Tunis, Tunisia
| | | | - Lilia BenFatma
- Nephrology Department, La Rabta University Hospital, Tunis, Tunisia
| | | | - Sabrine Boukhris
- Cardiology Department, La Rabta 2 (Pr Drissa) University Hospital, Tunis, Tunisia
| | - Manel Ben Halima
- Cardiology Department, La Rabta 1 (Pr Mourali) University Hospital, Tunis, Tunisia
| | - Nesrine Amdouni
- Cardiology Department B, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Chaima Ghorbel
- Cardiology Department, Habib Bourguiba Hospital, Medenine, Tunisia
| | - Sabrine Soudani
- Cardiology Department, La Rabta 2 (Pr Drissa) University Hospital, Tunis, Tunisia
| | | | - Syrine Triki
- Cardiology Department, Hedi Chaker-Sfax University Hospital, Sfax, Tunisia
| | | | - Imen Jemai
- Habib Bourguiba Hospital, Medenine, Tunisia
| | - Ouday Abdeljalil
- Cardiology Department B, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | - Amani Farah
- Cardiology Department B, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | - Zeineb Oumayma
- Cardiology Department, Charles Nicole University Hospital, Tunis, Tunisia
| | | | | | | | - Hela Sarray
- Cardiology Department, Hedi Chaker-Sfax University Hospital, Sfax, Tunisia
| | - Khalil Ouaghlani
- Cardiology Department, Charles Nicole University Hospital, Tunis, Tunisia
| | - Houssem Thabet
- Cardiology Department, Farhat Hached Hospital, Sousse, Tunisia
| | | | | | | | - Roueida Khalifa
- Cardiology Department B, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | - Yasmin Kammoun
- Cardiology Department, Hedi Chaker-Sfax University Hospital, Sfax, Tunisia
| | | | | | - Syrine Ben Jeddou
- Cardiology Department, La Rabta 2 (Pr Drissa) University Hospital, Tunis, Tunisia
| | | | | | - Najla Dammak
- Nephrology Department, Hedi Chaker-Sfax University Hospital, Sfax, Tunisia
| | | | | | | | - Faten Triki
- Cardiology Department, Hedi Chaker-Sfax University Hospital, Sfax, Tunisia
| | - Tarek Ellouz
- Cardiology Department, Hedi Chaker-Sfax University Hospital, Sfax, Tunisia
| | | | | | | | | | - Wejdene Wachtati
- Cardiology Department, Charles Nicole University Hospital, Tunis, Tunisia
| | | | | | - Fathia Meghaieth
- Cardiology Department, La Rabta 1 (Pr Mourali) University Hospital, Tunis, Tunisia
| | | | | | - Sarra Chenik
- Cardiology Department, The Main Military Instruction Hospital of Tunis, Tunis, Tunisia
| | | | | | | | | | - Sana Ouali
- Cardiology Department, La Rabta 1 (Pr Mourali) University Hospital, Tunis, Tunisia
| | - Mouna Chaker
- Cardiology Department, Hedi Chaker-Sfax University Hospital, Sfax, Tunisia
| | | | - Meriem Dghim
- Cardiology Department, The Main Military Instruction Hospital of Tunis, Tunis, Tunisia
| | | | | | - Ahmed Turki
- Cardiology Department, Hedi Chaker-Sfax University Hospital, Sfax, Tunisia
| | - Ihsen Zairi
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
| | | | - Safa Dardouri
- Cardiology Department, Farhat Hached Hospital, Sousse, Tunisia
| | | | | | | | | | - Khadija Mzoughi
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
| | | | - Afef BenHalima
- Cardiology Department, Abderrahmen Mami-Ariana Hospital, Ariana, Tunisia
| | | | | | | | | | | | - Rami Tlili
- Cardiology Department, Mongi Slim Hospital, Tunis, Tunisia
| | - Fares Azaiez
- Cardiology Department, Mongi Slim Hospital, Tunis, Tunisia
| | - Imen Bouhlel
- Cardiology Department, Farhat Hached Hospital, Sousse, Tunisia
| | | | | | | | - Leila Riahi
- Cardiology Department, The Main Military Instruction Hospital of Tunis, Tunis, Tunisia
| | | | | | - Amel BenSalem
- Cardiology Department, Charles Nicole University Hospital, Tunis, Tunisia
| | - Bassem Rekik
- Cardiology Department, Charles Nicole University Hospital, Tunis, Tunisia
| | | | | | | | - Yosra Mejdoub
- Community Medicine Department, Hedi Chaker-Sfax University Hospital, Sfax, Tunisia
| | - Imen Gtif
- Laboratory of Screening Cellular and Molecular Process, Centre of Biotechnology of Sfax, Sfax, Tunisia
| | - Gouider Jribi
- Cardiology Department, Farhat Hached Hospital, Sousse, Tunisia
| | - Elyes Naffeti
- Cardiology Department, University Hospital Sahloul, Sousse, Tunisia
| | - Habib Gamra
- Cardiology Department A, Fatouma Bourguiba Hospital, Monastir, Tunisia
| | - Soraya BenYousef
- Cardiology Department, Internal Security Forces Hospital, Tunis, Tunisia
| | - Wissem Sdiri
- Cardiology Department, Bougatfa Hospital, Bizerte, Tunisia
| | - Najeh BenHalima
- Cardiology Department, Ibn El Jazzar Hospital, Kairouan, Tunisia
| | | | - Salem Kachboura
- Cardiology Department, Abderrahmen Mami-Ariana Hospital, Ariana, Tunisia
| | - Sondes Kraiem
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Wafa Fehri
- Cardiology Department, The Main Military Instruction Hospital of Tunis, Tunis, Tunisia
| | - Leila Bazdeh
- Cardiology Department, Charles Nicole University Hospital, Tunis, Tunisia
| | - MohamedSami Mourali
- Cardiology Department, La Rabta 1 (Pr Mourali) University Hospital, Tunis, Tunisia
| | - Sami Milouchi
- Cardiology Department, Habib Bourguiba Hospital, Medenine, Tunisia
| | - Habiba Drissa
- Cardiology Department, La Rabta 2 (Pr Drissa) University Hospital, Tunis, Tunisia
| | - Faouzi Maatouk
- Cardiology Department B, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Lilia Zakhama
- Cardiology Department, Internal Security Forces Hospital, Tunis, Tunisia
| | - Faouzi Addad
- Cardiology Department, Abderrahmen Mami-Ariana Hospital, Ariana, Tunisia
| | - Samir Kammoun
- Cardiology Department, Hedi Chaker-Sfax University Hospital, Sfax, Tunisia
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Cernota M, Kroeber ES, Demeke T, Frese T, Getachew S, Kantelhardt EJ, Ngeh EN, Unverzagt S. Non-pharmacological interventions to achieve blood pressure control in African patients: a systematic review. BMJ Open 2022; 12:e048079. [PMID: 35228272 PMCID: PMC8886440 DOI: 10.1136/bmjopen-2020-048079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This systematic review aims to evaluate the evidence of non-pharmacological strategies to improve blood pressure (BP) control in patients with hypertension from African countries. DESIGN We performed a systematic review and searched Medline, Central, CINAHL and study registers until June 2020 for randomised studies on interventions to decrease BP of patients with hypertension in African countries. We assessed the study quality using the Cochrane risk of bias tool and narratively synthesised studies on non-pharmacological hypertension interventions. SETTING We included studies conducted in African countries. PARTICIPANTS Adult African patients with a hypertension diagnosis. INTERVENTIONS Studies on non-pharmacological interventions aiming to improve BP control and treatment adherence. OUTCOMES Main outcomes were BP and treatment adherence. RESULTS We identified 5564 references, included 23 with altogether 18 153 participants from six African countries. The studies investigated educational strategies to improve adherence (11 studies) and treatment by healthcare professionals (5 studies), individualised treatment strategies (2 studies), strategies on lifestyle including physical activity (4 studies) and modified nutrition (1 study). Nearly all studies on educational strategies stated improved adherence, but only three studies showed a clinically relevant improvement of BP control. All studies on individualised strategies and lifestyle changes resulted in clinically relevant effects on BP. Due to the type of interventions studied, risk of bias in domain blinding of staff/participants was frequent (83%). Though incomplete outcome data in 61% of the studies are critical, the general study quality was reasonable. CONCLUSIONS The identified studies offer diverse low-cost interventions including educative and task-shifting strategies, individualised treatment and lifestyle modifications to improve BP control. Especially trialled physical activity interventions show clinically relevant BP changes. All strategies were trialled in African countries and may be used for recommendations in evidence-based guidelines on hypertension in African settings. PROSPERO REGISTRATION NUMBER CRD42018075062.
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Affiliation(s)
- Monique Cernota
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin-Luther-Universität Halle-Wittenberg Medizinische Fakultät, Halle, Germany
| | - Eric Sven Kroeber
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin-Luther-Universität Halle-Wittenberg Medizinische Fakultät, Halle, Germany
| | - Tamiru Demeke
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin-Luther-Universität Halle-Wittenberg Medizinische Fakultät, Halle, Germany
| | - Sefonias Getachew
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Center of Health Sciences, Martin-Luther-Universität Halle-Wittenberg Medizinische Fakultät, Halle, Germany
| | - Etienne Ngeh Ngeh
- Physiotherapy Department, Regional Hospital Bamenda, Bamenda, Cameroon
- Research Organization for Health Education and Rehabilitation-Cameroon(ROHER-CAM), St. Louis University Bamenda, Bamenda, Cameroon
- African Regional Community, Guidelines International Network (G-I-N), Bamenda, Cameroon
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin-Luther-Universität Halle-Wittenberg Medizinische Fakultät, Halle, Germany
- Department of Primary Care, Universität Leipzig Medizinische Fakultät, Leipzig, Germany
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Majumdar U, Nanyonga Clarke R, Moran AE, Doupe P, Gadikota-Klumpers DD, Gidio A, Ssentamu D, Heller DJ. Hypertension screening, prevalence, treatment, and control at a large private hospital in Kampala, Uganda: A retrospective analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000386. [PMID: 36962239 PMCID: PMC10021338 DOI: 10.1371/journal.pgph.0000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022]
Abstract
Adult hypertension prevalence in Uganda is 27%, but only 8% are aware of their diagnosis, accordingly treatment and control levels are limited. The private sector provides at least half of care nationwide, but little is known about its effectiveness in hypertension control. We analyzed clinical data from 39 235 outpatient visits among 17 777 adult patients from July 2017 to August 2018 at Uganda's largest private hospital. We calculated blood pressure screening rate at every visit, and hypertension prevalence, medication treatment, and control rates among the 5 090 patients with two or more blood pressure checks who received any medications from the hospital's pharmacy. We defined hypertension in this group as 1) an average of two blood pressure measurements at separate consecutive visits, higher than 140 mm Hg systolic or 90 mm Hg diastolic, 2) receipt of any antihypertensive medication, or 3) the use of a hypertension electronic medical record code. We deemed hypertension control as normotensive at the most recent check. 12 821 (72.1%) of patients received at least 1 blood pressure check. Among the 5 090 patients above, 2 121 (41.6%) had hypertension (33.4% age-standardized to a world population standard): 1 915 (37.6%) with elevated blood pressure, and 170 (3.3%) were normotensive but receiving medication. 838 (39.4%) of patients with hypertension received medication at least once. Overall, 18.3% of patients achieved control (27% of treated patients, and 15% of untreated patients). Hypertension is common and incompletely controlled in this Ugandan private-sector population, suggesting several avenues for novel interventions.
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Affiliation(s)
- Usnish Majumdar
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | - Andrew E Moran
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | | | - Darinka D Gadikota-Klumpers
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Agaba Gidio
- Clarke International University, Kampala, Uganda
| | | | - David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Gandhi P A, Kathirvel S, Chakraborty S. Rural community health workers’ readiness for mobile-phone based telemedicine uptake in India. J Rural Med 2022; 17:166-170. [PMID: 35847763 PMCID: PMC9263958 DOI: 10.2185/jrm.2021-044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 04/18/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Aravind Gandhi P
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, India
| | - Soundappan Kathirvel
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, India
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Pillsbury MKM, Mwangi E, Andesia J, Njuguna B, Bloomfield GS, Chepchumba A, Kamano J, Mercer T, Miheso J, Pastakia SD, Pathak S, Thakkar A, Naanyu V, Akwanalo C, Vedanthan R. Human-centered implementation research: a new approach to develop and evaluate implementation strategies for strengthening referral networks for hypertension in western Kenya. BMC Health Serv Res 2021; 21:910. [PMID: 34479556 PMCID: PMC8414706 DOI: 10.1186/s12913-021-06930-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Human-centered design (HCD) is an increasingly recognized approach for engaging stakeholders and developing contextually appropriate health interventions. As a component of the ongoing STRENGTHS study (Strengthening Referral Networks for Management of Hypertension Across the Health System), we report on the process and outcomes of utilizing HCD to develop the implementation strategy prior to a cluster-randomized controlled trial. METHODS We organized a design team of 15 local stakeholders to participate in an HCD process to develop implementation strategies. We tested prototypes for acceptability, appropriateness, and feasibility through focus group discussions (FGDs) with various community stakeholder groups and a pilot study among patients with hypertension. FGD transcripts underwent content analysis, and pilot study data were analyzed for referral completion and reported barriers to referral. Based on this community feedback, the design team iteratively updated the implementation strategy. During each round of updates, the design team reflected on their experience through FGDs and a Likert-scale survey. RESULTS The design team developed an implementation strategy consisting of a combined peer navigator and a health information technology (HIT) package. Overall, community participants felt that the strategy was acceptable, appropriate, and feasible. During the pilot study, 93% of referrals were completed. FGD participants felt that the implementation strategy facilitated referral completion through active peer engagement; enhanced communication between clinicians, patients, and health administrators; and integrated referral data into clinical records. Challenges included referral barriers that were not directly addressed by the strategy (e.g. transportation costs) and implementation of the HIT package across multiple health record systems. The design team reflected that all members contributed significantly to the design process, but emphasized the need for more transparency in how input from study investigators was incorporated into design team discussions. CONCLUSIONS The adaptive process of co-creation, prototyping, community feedback, and iterative redesign aligned our implementation strategy with community stakeholder priorities. We propose a new framework of human-centered implementation research that promotes collaboration between community stakeholders, study investigators, and the design team to develop, implement, and evaluate HCD products for implementation research. Our experience provides a feasible and replicable approach for implementation research in other settings. TRIAL REGISTRATION Clinicaltrials.gov, NCT02501746 , registration date: July 17, 2015.
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Affiliation(s)
- Mc Kinsey M Pillsbury
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Eunice Mwangi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Andesia
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | | | - Agneta Chepchumba
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jemima Kamano
- Moi Teaching and Referral Hospital, Eldoret, Kenya
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Tim Mercer
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Juliet Miheso
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sonak D Pastakia
- Center for Health Equity and Innovation, Purdue University, West Lafayette, IN, USA
| | | | | | - Violet Naanyu
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | | | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 8th floor, New York, NY, 10016, USA.
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Hickey MD, Ayieko J, Owaraganise A, Sim N, Balzer LB, Kabami J, Atukunda M, Opel FJ, Wafula E, Nyabuti M, Brown L, Chamie G, Jain V, Peng J, Kwarisiima D, Camlin CS, Charlebois ED, Cohen CR, Bukusi EA, Kamya MR, Petersen ML, Havlir DV. Effect of a patient-centered hypertension delivery strategy on all-cause mortality: Secondary analysis of SEARCH, a community-randomized trial in rural Kenya and Uganda. PLoS Med 2021; 18:e1003803. [PMID: 34543267 PMCID: PMC8489716 DOI: 10.1371/journal.pmed.1003803] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 10/04/2021] [Accepted: 09/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypertension treatment reduces morbidity and mortality yet has not been broadly implemented in many low-resource settings, including sub-Saharan Africa (SSA). We hypothesized that a patient-centered integrated chronic disease model that included hypertension treatment and leveraged the HIV care system would reduce mortality among adults with uncontrolled hypertension in rural Kenya and Uganda. METHODS AND FINDINGS This is a secondary analysis of the SEARCH trial (NCT:01864603), in which 32 communities underwent baseline population-based multidisease testing, including hypertension screening, and were randomized to standard country-guided treatment or to a patient-centered integrated chronic care model including treatment for hypertension, diabetes, and HIV. Patient-centered care included on-site introduction to clinic staff at screening, nursing triage to expedite visits, reduced visit frequency, flexible clinic hours, and a welcoming clinic environment. The analytic population included nonpregnant adults (≥18 years) with baseline uncontrolled hypertension (blood pressure ≥140/90 mm Hg). The primary outcome was 3-year all-cause mortality with comprehensive population-level assessment. Secondary outcomes included hypertension control assessed at a population level at year 3 (defined per country guidelines as at least 1 blood pressure measure <140/90 mm Hg on 3 repeated measures). Between-arm comparisons used cluster-level targeted maximum likelihood estimation. Among 86,078 adults screened at study baseline (June 2013 to July 2014), 10,928 (13%) had uncontrolled hypertension. Median age was 53 years (25th to 75th percentile 40 to 66); 6,058 (55%) were female; 677 (6%) were HIV infected; and 477 (4%) had diabetes mellitus. Overall, 174 participants (3.2%) in the intervention group and 225 participants (4.1%) in the control group died during 3 years of follow-up (adjusted relative risk (aRR) 0.79, 95% confidence interval (CI) 0.64 to 0.97, p = 0.028). Among those with baseline grade 3 hypertension (≥180/110 mm Hg), 22 (4.9%) in the intervention group and 42 (7.9%) in the control group died during 3 years of follow-up (aRR 0.62, 95% CI 0.39 to 0.97, p = 0.038). Estimated population-level hypertension control at year 3 was 53% in intervention and 44% in control communities (aRR 1.22, 95% CI 1.12 to 1.33, p < 0.001). Study limitations include inability to identify specific causes of death and control conditions that exceeded current standard hypertension care. CONCLUSIONS In this cluster randomized comparison where both arms received population-level hypertension screening, implementation of a patient-centered hypertension care model was associated with a 21% reduction in all-cause mortality and a 22% improvement in hypertension control compared to standard care among adults with baseline uncontrolled hypertension. Patient-centered chronic care programs for HIV can be leveraged to reduce the overall burden of cardiovascular mortality in SSA. TRIAL REGISTRATION ClinicalTrials.gov NCT01864603.
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Affiliation(s)
- Matthew D. Hickey
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | - James Ayieko
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Nicholas Sim
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Laura B. Balzer
- School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Jane Kabami
- Infectious Disease Research Collaboration, Kampala, Uganda
| | | | - Fredrick J. Opel
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Erick Wafula
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Marilyn Nyabuti
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lillian Brown
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | - Gabriel Chamie
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | - Vivek Jain
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | - James Peng
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
| | | | - Carol S. Camlin
- Center for AIDS Prevention Studies & Department of Medicine, UCSF, San Francisco, California, United States of America
| | - Edwin D. Charlebois
- Center for AIDS Prevention Studies & Department of Medicine, UCSF, San Francisco, California, United States of America
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, California, United States of America
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Moses R. Kamya
- Infectious Disease Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Maya L. Petersen
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Diane V. Havlir
- Division of HIV, ID, & Global Medicine, Department of Medicine, UCSF, San Francisco, California, United States of America
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Huangfu H, Yu Q, Shi P, Shen Q, Zhang Z, Chen Z, Pu C, Xu L, Hu Z, Ma A, Gong Z, Xu T, Wang P, Wang H, Hao C, Zhou Q, Li L, Li C, Hao M. The Impacts of Regional Regulatory Policies on the Prevention and Control of Chronic Diseases in China: A Mediation Analysis. Healthcare (Basel) 2021; 9:healthcare9081058. [PMID: 34442195 PMCID: PMC8392473 DOI: 10.3390/healthcare9081058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/10/2021] [Accepted: 08/15/2021] [Indexed: 11/17/2022] Open
Abstract
Regional regulatory policies (RPs) are a major factor in the prevention and control of chronic diseases (PCCDs) through the implementation of various measures. This study aimed to explore the impacts of RPs on PCCDs, with a focus on the mediating roles of community service. The soundness of the regulatory mechanism (SORM) was used to measure the soundness of RPs based on 1095 policy documents (updated as of 2015). Coverage provided by community service institutions (CSIs) and community health centres (CHCs) was used to represent community service coverage derived from the China Statistical Yearbook (2015), while the number of chronic diseases (NCDs) was used to measure the effects of PCCDs based on data taken from the 2015 China Health and Retirement Longitudinal Study survey. To assess the relationship between SORM, NCDs and community service, a negative binomial regression model and mediation analysis with bootstrapping were conducted. Results revealed that there was a negative correlation between SORM and NCDs. CSIs had a major effect on the relationship between RPs and PCCDs, while CHCs had a partial mediating effect. RPs can effectively prevent and control chronic diseases. Increased effort should also be aimed at strengthening the roles of CSIs and CHCs.
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Affiliation(s)
- Huihui Huangfu
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (H.H.); (Q.Y.); (Q.Z.); (L.L.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
| | - Qinwen Yu
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (H.H.); (Q.Y.); (Q.Z.); (L.L.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
| | - Peiwu Shi
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Zhejiang Academy of Medical Sciences, Hangzhou 310012, China
| | - Qunhong Shen
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Public Policy and Management, Tsinghua University, Beijing 100084, China
| | - Zhaoyang Zhang
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Project Supervision Center of National Health Commission of the People’s Republic of China, Beijing 100044, China
| | - Zheng Chen
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Grassroots Public Health Management Group, Public Health Management Branch of Chinese Preventive Medicine Association, Shanghai 201800, China
| | - Chuan Pu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Lingzhong Xu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Public Health, Shandong University, Jinan 250012, China
| | - Zhi Hu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Health Service Management, Anhui Medical University, Hefei 230032, China
| | - Anning Ma
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Public Health, Jining Medical University, Jining 272067, China
| | - Zhaohui Gong
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Committee on Medicine and Health of Central Committee of China ZHI GONG PARTY, Beijing 100011, China
| | - Tianqiang Xu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Institute of Inspection and Supervision, Shanghai Municipal Health Commission, Shanghai 200031, China
| | - Panshi Wang
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Shanghai Municipal Health Commission, Shanghai 200031, China
| | - Hua Wang
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Jiangsu Preventive Medicine Association, Nanjing 210009, China
| | - Chao Hao
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Changzhou Center for Disease Control and Prevention, Changzhou 213003, China
| | - Qingyu Zhou
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (H.H.); (Q.Y.); (Q.Z.); (L.L.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
| | - Li Li
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (H.H.); (Q.Y.); (Q.Z.); (L.L.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
| | - Chengyue Li
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (H.H.); (Q.Y.); (Q.Z.); (L.L.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Correspondence: (C.L.); (M.H.); Tel.: +86-21-33561022(C.L. & M.H.)
| | - Mo Hao
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (H.H.); (Q.Y.); (Q.Z.); (L.L.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Correspondence: (C.L.); (M.H.); Tel.: +86-21-33561022(C.L. & M.H.)
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Abstract
PURPOSE OF REVIEW Hypertension (HTN) is the most prevalent risk factor for cardiovascular disease (CVD) worldwide, affecting 1.39 billion people. This review discusses recent literature regarding the global burden of HTN and emerging concepts in prevalence, treatment, and control in different regions around the globe. RECENT FINDINGS Community-based interventions and telemedicine may be useful in increasing access to care and identifying/assisting patients with HTN, especially in populations with geographical and economic barriers to healthcare. Home blood pressure monitoring is beneficial for HTN control in diverse regions. Polypills have proven benefits to decrease HTN and CVD risk. Continuation of treatment with angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers in high risk COVID-19 patients appears appropriate. SUMMARY Extensive research demonstrates that early screening/treatment, lifestyle modification, and pharmacotherapy are essential to control HTN worldwide. This review highlights recent research and novel concepts on effective interventions being used globally.
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Dong R, Leung C, Naert MN, Naanyu V, Kiptoo P, Matelong W, Matini E, Orango V, Bloomfield GS, Edelman D, Fuster V, Manyara S, Menya D, Pastakia SD, Valente T, Kamano J, Horowitz CR, Vedanthan R. Chronic disease stigma, skepticism of the health system, and socio-economic fragility: Qualitative assessment of factors impacting receptiveness to group medical visits and microfinance for non-communicable disease care in rural Kenya. PLoS One 2021; 16:e0248496. [PMID: 34097700 PMCID: PMC8183981 DOI: 10.1371/journal.pone.0248496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading cause of mortality in the world, and innovative approaches to NCD care delivery are being actively developed and evaluated. Combining the group-based experience of microfinance and group medical visits is a novel approach to NCD care delivery. However, the contextual factors, facilitators, and barriers impacting wide-scale implementation of these approaches within a low- and middle-income country setting are not well known. METHODS Two types of qualitative group discussion were conducted: 1) mabaraza (singular, baraza), a traditional East African community gathering used to discuss and exchange information in large group settings; and 2) focus group discussions (FGDs) among rural clinicians, community health workers, microfinance group members, and patients with NCDs. Trained research staff members led the discussions using structured question guides. Content analysis was performed with NVivo using deductive and inductive codes that were then grouped into themes. RESULTS We conducted 5 mabaraza and 16 FGDs. A total of 205 individuals (113 men and 92 women) participated in the mabaraza, while 162 individuals (57 men and 105 women) participated in the FGDs. In the context of poverty and previous experiences with the health system, participants described challenges to NCD care across three themes: 1) stigma of chronic disease, 2) earned skepticism of the health system, and 3) socio-economic fragility. However, they also outlined windows of opportunity and facilitators of group medical visits and microfinance to address those challenges. DISCUSSION Our qualitative study revealed actionable factors that could impact the success of implementation of group medical visits and microfinance initiatives for NCD care. While several challenges were highlighted, participants also described opportunities to address and mitigate the impact of these factors. We anticipate that our approach and analysis provides new insights and methodological techniques that will be relevant to other low-resource settings worldwide.
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Affiliation(s)
- Rae Dong
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Claudia Leung
- Duke University Medical Center, Durham, North Carolina, United States of America
| | - Mackenzie N. Naert
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Peninah Kiptoo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Winnie Matelong
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Esther Matini
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Vitalis Orango
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Gerald S. Bloomfield
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - David Edelman
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Simon Manyara
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Diana Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | - Sonak D. Pastakia
- Center for Health Equity and Innovation, Purdue University College of Pharmacy, West Lafayette, Indiana, United States of America
| | - Tom Valente
- Keck School of Medicine of USC, Los Angeles, California, United States of America
| | - Jemima Kamano
- College of Health Sciences, Moi University, Eldoret, Kenya
| | - Carol R. Horowitz
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Rajesh Vedanthan
- NYU Grossman School of Medicine, New York, NY, United States of America
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Sikka N, DeLong A, Kamano J, Kimaiyo S, Orango V, Andesia J, Fuster V, Hogan J, Vedanthan R. Sex differences in health status, healthcare utilization, and costs among individuals with elevated blood pressure: the LARK study from Western Kenya. BMC Public Health 2021; 21:948. [PMID: 34011345 PMCID: PMC8136119 DOI: 10.1186/s12889-021-10995-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elevated blood pressure is the leading risk factor for global mortality. While it is known that there exist differences between men and women with respect to socioeconomic status, self-reported health, and healthcare utilization, there are few published studies from Africa. This study therefore aims to characterize differences in self-reported health status, healthcare utilization, and costs between men and women with elevated blood pressure in Kenya. METHODS Data from 1447 participants enrolled in the LARK Hypertension study in western Kenya were analyzed. Latent class analysis based on five dependent variables was performed to describe patterns of healthcare utilization and costs in the study population. Regression analysis was then performed to describe the relationship between different demographics and each outcome. RESULTS Women in our study had higher rates of unemployment (28% vs 12%), were more likely to report lower monthly earnings (72% vs 51%), and had more outpatient visits (39% vs 28%) and pharmacy prescriptions (42% vs 30%). Women were also more likely to report lower quality-of-life and functional health status, including pain, mobility, self-care, and ability to perform usual activities. Three patterns of healthcare utilization were described: (1) individuals with low healthcare utilization, (2) individuals who utilized care and paid high out-of-pocket costs, and (3) individuals who utilized care but had lower out-of-pocket costs. Women and those with health insurance were more likely to be in the high-cost utilizer group. CONCLUSIONS Men and women with elevated blood pressure in Kenya have different health care utilization behaviors, cost and economic burdens, and self-perceived health status. Awareness of these sex differences can help inform targeted interventions in these populations.
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Affiliation(s)
- Neha Sikka
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Allison DeLong
- Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Jemima Kamano
- Department of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Sylvester Kimaiyo
- Department of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Vitalis Orango
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Andesia
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Joseph Hogan
- Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
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Vedanthan R, Kamano JH, Chrysanthopoulou SA, Mugo R, Andama B, Bloomfield GS, Chesoli CW, DeLong AK, Edelman D, Finkelstein EA, Horowitz CR, Manyara S, Menya D, Naanyu V, Orango V, Pastakia SD, Valente TW, Hogan JW, Fuster V. Group Medical Visit and Microfinance Intervention for Patients With Diabetes or Hypertension in Kenya. J Am Coll Cardiol 2021; 77:2007-2018. [PMID: 33888251 PMCID: PMC8065205 DOI: 10.1016/j.jacc.2021.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incorporating social determinants of health into care delivery for chronic diseases is a priority. OBJECTIVES The goal of this study was to evaluate the impact of group medical visits and/or microfinance on blood pressure reduction. METHODS The authors conducted a cluster randomized trial with 4 arms and 24 clusters: 1) usual care (UC); 2) usual care plus microfinance (MF); 3) group medical visits (GMVs); and 4) GMV integrated into MF (GMV-MF). The primary outcome was 1-year change in systolic blood pressure (SBP). Mixed-effects intention-to-treat models were used to evaluate the outcomes. RESULTS A total of 2,890 individuals (69.9% women) were enrolled (708 UC, 709 MF, 740 GMV, and 733 GMV-MF). Average baseline SBP was 157.5 mm Hg. Mean SBP declined -11.4, -14.8, -14.7, and -16.4 mm Hg in UC, MF, GMV, and GMV-MF, respectively. Adjusted estimates and multiplicity-adjusted 98.3% confidence intervals showed that, relative to UC, SBP reduction was 3.9 mm Hg (-8.5 to 0.7), 3.3 mm Hg (-7.8 to 1.2), and 2.3 mm Hg (-7.0 to 2.4) greater in GMV-MF, GMV, and MF, respectively. GMV and GMV-MF tended to benefit women, and MF and GMV-MF tended to benefit poorer individuals. Active participation in GMV-MF was associated with greater benefit. CONCLUSIONS A strategy combining GMV and MF for individuals with diabetes or hypertension in Kenya led to clinically meaningful SBP reductions associated with cardiovascular benefit. Although the significance threshold was not met in pairwise comparison hypothesis testing, confidence intervals for GMV-MF were consistent with impacts ranging from substantive benefit to neutral effect relative to UC. Incorporating social determinants of health into care delivery for chronic diseases has potential to improve outcomes. (Bridging Income Generation With Group Integrated Care [BIGPIC]; NCT02501746).
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Affiliation(s)
- Rajesh Vedanthan
- New York University Grossman School of Medicine, New York, New York, USA.
| | - Jemima H Kamano
- School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Richard Mugo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Benjamin Andama
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | | | - Eric A Finkelstein
- Duke University, Durham, North Carolina, USA; Duke-National University of Singapore Medical School, Singapore
| | - Carol R Horowitz
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Simon Manyara
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Diana Menya
- School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Vitalis Orango
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Jafar TH, Kyobutungi C. A Good Start to Lowering BP and CVD Risk in Sub-Saharan Africa. J Am Coll Cardiol 2021; 77:2019-2021. [PMID: 33888252 DOI: 10.1016/j.jacc.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
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Otieno HA, Miezah C, Yonga G, Kueffer F, Guy M, Lang'At C, Hettrick DA, Schmieder R. Improved blood pressure control via a novel chronic disease management model of care in sub‐Saharan Africa: Real‐world program implementation results. J Clin Hypertens (Greenwich) 2021; 23:785-792. [PMID: 33471442 PMCID: PMC8678676 DOI: 10.1111/jch.14174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/18/2020] [Accepted: 12/27/2020] [Indexed: 12/21/2022]
Abstract
A chronic disease management model of care (Empower Health) was launched in rural and urban areas of Ghana and Kenya in 2018. The goal was to improve disease awareness, reduce the burden of disease, and improve the clinical effectiveness and efficiency of managing hypertension. Leveraging the model, clinicians provide patients with tailored management plans. Patients accessed regular blood pressure checks at home, at the clinic, or at community‐partner locations where they received real‐time feedback. On the mobile application, clinicians viewed patient data, provided direct patient feedback, and wrote electronic prescriptions accessible through participating pharmacies. To date, 1266 patients had been enrolled in the “real‐world” implementation cohort and followed for an average of 351 ± 133 days across 5 facilities. Average baseline systolic blood pressure (SBP) was 145 ± 21 mmHg in the overall cohort and 159 ± 16 mmHg in the subgroup with uncontrolled hypertension (n = 743) as defined by baseline SBP ≥ 140 mmHg. SBP decreased significantly through 12 months in both the overall cohort (−9.4 mmHg, p < .001) and in the uncontrolled subgroup (−17.6 mmHg, p < .001). The proportion patients with controlled pressure increased from 46% at baseline to 77% at 12 months (p < .001). In summary, a new chronic disease management model of care improved and sustained blood pressure control to 12 months, especially in those with elevated blood pressure at enrollment.
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Affiliation(s)
| | | | - Gerald Yonga
- School of Medicine University of Nairobi Nairobi Kenya
| | | | | | | | | | - Roland Schmieder
- Department of Nephrology and Hypertension University Hospital of the Friedrich‐Alexander University Erlangen‐Nürnberg Erlangen Germany
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Vedanthan R, Kumar A, Kamano JH, Chang H, Raymond S, Too K, Tulienge D, Wambui C, Bagiella E, Fuster V, Kimaiyo S. Effect of Nurse-Based Management of Hypertension in Rural Western Kenya. Glob Heart 2020; 15:77. [PMID: 33299773 PMCID: PMC7716784 DOI: 10.5334/gh.856] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/06/2020] [Indexed: 01/23/2023] Open
Abstract
Background Elevated blood pressure is the leading cause of death worldwide; however, treatment and control rates remain very low. An expanding literature supports the strategy of task redistribution of hypertension care to nurses. Objective We aimed to evaluate the effect of a nurse-based hypertension management program in Kenya. Methods We conducted a retrospective data analysis of patients with hypertension who initiated nurse-based hypertension management care between January 1, 2011, and October 31, 2013. The primary outcome measure was change in systolic blood pressure (SBP) over one year, analyzed using piecewise linear mixed-effect models with a cut point at 3 months. The primary comparison of interest was care provided by nurses versus clinical officers. Secondary outcomes were change in diastolic blood pressure (DBP) over one year, and blood pressure control analyzed using a zero-inflated Poisson model. Results The cohort consisted of 1051 adult patients (mean age 61 years; 65% women). SBP decreased significantly from baseline to three months (nurse-managed patients: slope -4.95 mmHg/month; clinical officer-managed patients: slope -5.28), with no significant difference between groups. DBP also significantly decreased from baseline to three months with no difference between provider groups. Retention in care at 12 months was 42%. Conclusions Nurse-managed hypertension care can significantly improve blood pressure. However, retention in care remains a challenge. If these results are reproduced in prospective trial settings with improvements in retention in care, this could be an effective strategy for hypertension care worldwide.
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Affiliation(s)
- Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, US
| | - Anirudh Kumar
- Department of Medicine, NYU Grossman School of Medicine, New York, US
| | - Jemima H. Kamano
- Department of Medicine, School of Medicine, Moi University College of Health Sciences, Eldoret, KE
- Chronic Disease Management, Academic Model Providing Access to Healthcare, Eldoret, KE
| | - Helena Chang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, US
| | - Samantha Raymond
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, US
| | - Kenneth Too
- Chronic Disease Management, Academic Model Providing Access to Healthcare, Eldoret, KE
| | - Deborah Tulienge
- Chronic Disease Management, Academic Model Providing Access to Healthcare, Eldoret, KE
| | - Charity Wambui
- Chronic Disease Management, Academic Model Providing Access to Healthcare, Eldoret, KE
| | - Emilia Bagiella
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, US
| | - Valentin Fuster
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, US
| | - Sylvester Kimaiyo
- Department of Medicine, School of Medicine, Moi University College of Health Sciences, Eldoret, KE
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Ferdinand KC. Uncontrolled hypertension in sub-Saharan Africa: Now is the time to address a looming crisis. J Clin Hypertens (Greenwich) 2020; 22:2111-2113. [PMID: 32951284 PMCID: PMC8030060 DOI: 10.1111/jch.14046] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Keith C. Ferdinand
- Tulane Heart and Vascular InstituteTulane University School of MedicineNew OrleansLouisianaUSA
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Abstract
: As coronavirus disease 2019 (Covid-19) restrictions upend the community bonds that have enabled African communities to thrive in the face of numerous challenges, it is vital that the gains made in community-based healthcare are preserved by adapting our approaches. Instead of reversing the many gains made through locally driven development partnerships with international funding agencies for other viral diseases like HIV, we must use this opportunity to adapt the many lessons learned to address the burden of Covid-19. Programs like the Academic Model Providing Access to Healthcare are currently leveraging widely available technologies in Africa to prevent patients from experiencing significant interruptions in care as the healthcare system adjusts to the challenges presented by Covid-19. These approaches are designed to preserve social contact while incorporating physical distancing. The gains and successes made through approaches like group-based medical care must not only continue but can help expand upon the extraordinary success of programs like President's Emergency Plan for AIDS Relief.
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D'Amario D, Canonico F, Rodolico D, Borovac JA, Vergallo R, Montone RA, Galli M, Migliaro S, Restivo A, Massetti M, Crea F. Telemedicine, Artificial Intelligence and Humanisation of Clinical Pathways in Heart Failure Management: Back to the Future and Beyond. Card Fail Rev 2020; 6:e16. [PMID: 32612852 PMCID: PMC7312813 DOI: 10.15420/cfr.2019.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/12/2020] [Indexed: 12/28/2022] Open
Abstract
New technologies have been recently introduced to improve the monitoring of patients with chronic syndromes such as heart failure. Devices can now be employed to gather large amounts of data and data processing through artificial intelligence techniques may improve heart failure management and reduce costs. The analysis of large datasets using an artificial intelligence technique is leading to a paradigm shift in the era of precision medicine. However, the assessment of clinical safety and the evaluation of the potential benefits is still a matter of debate. In this article, the authors aim to focus on the development of these new tools and to draw the attention to their transition in daily clinical practice.
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Affiliation(s)
- Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Francesco Canonico
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Daniele Rodolico
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Josip A Borovac
- Department of Pathophysiology, University of Split School of Medicine Split, Croatia.,Working Group on Heart Failure of Croatian Cardiac Society Zagreb, Croatia
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Stefano Migliaro
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS Rome, Italy
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Mercer T, Nulu S, Vedanthan R. Innovative Implementation Strategies for Hypertension Control in Low- and Middle-Income Countries: a Narrative Review. Curr Hypertens Rep 2020; 22:39. [PMID: 32405820 DOI: 10.1007/s11906-020-01045-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the most recent and innovative implementation strategies for hypertension control in low- and middle-income countries (LMICs). RECENT FINDINGS Implementation strategies from Latin America, Africa, and Asia were organized across three levels: community, health system, and policy/population. Multicomponent interventions involving task-shifting strategies, with or without mobile health tools, had the most supporting evidence, with policy or population-level interventions having the least, focused only on salt reduction with mixed results. More research is needed to better understand how context affects intervention implementation. There is an emerging evidence base for implementation strategies for hypertension control and CVD risk reduction in LMICs at the community and health system levels, but further research is needed to determine the most effective policy and population-level strategies. How to best account for local context in adapting and implementing these evidence-based interventions in LMICs still remains largely unknown. Accelerating the translation of this implementation research into policy and practice is imperative to improve health and save lives globally.
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Affiliation(s)
- Tim Mercer
- Department of Population Health, Division of Global Health, The University of Texas at Austin Dell Medical School, 1601 Trinity St., Bldg. B, Austin, TX, 78712, USA.
| | - Shanti Nulu
- Department of Internal Medicine, Division of Cardiology, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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Rader F, Blyler CA. Finding Hay in the Haystack. J Am Coll Cardiol 2019; 74:1907-1909. [PMID: 31601370 DOI: 10.1016/j.jacc.2019.08.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/15/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Florian Rader
- Hypertension Center of Excellence, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - C Adair Blyler
- Hypertension Center of Excellence, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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