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Hasan MJ, Hossain MZ, Hossain MA, Dalal K, Baset MA, Sutradhar P, Alam M, Tabassum T, Fardous J, Zaman P, Rafi MA, Khan MAS, Hawlader MDH. Health-care-seeking behaviour in patients with hypertension: experience from a dedicated hypertension centre in Bangladesh. Blood Press 2024; 33:2339434. [PMID: 38696746 DOI: 10.1080/08037051.2024.2339434] [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: 05/16/2023] [Accepted: 03/22/2024] [Indexed: 05/04/2024]
Abstract
Objective: The study aimed to assess health-seeking behaviour (HSB) and associated factors among hypertensive patients in Bangladesh.Methods: This cross-sectional study was conducted in the Hypertension & Research Centre, Rangpur, Bangladesh, between January 2022 and June 2022. A total of 497 hypertensive adults were recruited consecutively. A pre-tested structured questionnaire was deployed by the research team for data collection. Multivariable logistic regression analysis was used to explore the predictors of HSB.Results: The mean age of the hypertensive patients was 52 ± 11 (SD) years. Most of them were aged between 51 and 60 years (33%), female (55%), came from rural areas (57%), and belonged to middle socioeconomic class (68%). One-fourth of the patients (27%) had chosen informal healthcare providers for their first consultation. Fear of stroke (244, 45%), headache (170, 36%), and neck pain (81, 17%) were the three most common compelling causes of their visit to the hypertension centre. Age (aOR 0.78, 95% CI 0.68 - 0.89), male sex (aOR: 1.79, 95% CI 1.05 - 3.10), living in semi-urban (aOR 4.68, 95% CI 1.45 - 15.10) and rural area (aOR 1.68, 95% CI 1.01 - 2.80), farmers as occupation (aOR: 3.24, 95%CI: 1.31 - 8.06) and belonging to lower social economic class (aOR 4.24, 95% CI 1.68 - 10.69) were predictors of visiting informal providers of hypertensive patient. One-fourth of the hypertensive patients received consultation from informal healthcare providers.Conclusions: Raising awareness among patients and proper referral to specialised hypertension centres could promulgate the patients towards appropriate behaviour.
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Affiliation(s)
| | | | | | - Koustuv Dalal
- Division of Public Health Science, Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | | | | | - Mahabubul Alam
- Tropical Disease and Health Research Center, Dhaka, Bangladesh
| | | | | | - Paramita Zaman
- Tropical Disease and Health Research Center, Dhaka, Bangladesh
| | - Md Abdur Rafi
- Tropical Disease and Health Research Center, Dhaka, Bangladesh
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Ahmed SM, Krishnan A, Karim O, Shafique K, Naher N, Srishti SA, Raj A, Ahmed S, Rawal L, Adams A. Delivering non-communicable disease services through primary health care in selected south Asian countries: are health systems prepared? Lancet Glob Health 2024; 12:e1706-e1719. [PMID: 39178879 DOI: 10.1016/s2214-109x(24)00118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 02/06/2024] [Accepted: 03/05/2024] [Indexed: 08/26/2024]
Abstract
In the south Asian region, delivering non-communicable disease (NCD) prevention and control services through existing primary health-care (PHC) facilities is urgently required yet currently challenging. As the first point of contact with the health-care system, PHC offers an ideal window for prevention and continuity of care over the life course, yet the implementation of PHC to address NCDs is insufficient. This review considers evidence from five south Asian countries to derive policy-relevant recommendations for designing integrated PHC systems that include NCD care. Findings reveal high political commitment but poor multisectoral engagement and health systems preparedness for tackling chronic diseases at the PHC level. There is a shortage of skilled human resources, requisite infrastructure, essential NCD medicines and technologies, and dedicated financing. Although innovations supporting integrated interventions exist, such as innovations focusing on community-centric approaches, scaling up remains problematic. To deliver NCD services sustainably, governments must aim for increased financing and a redesign of PHC service.
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Affiliation(s)
- Syed Masud Ahmed
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, New Delhi, India
| | - Obaida Karim
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Kashif Shafique
- School of Public Health, Dow University of Health Sciences, Gulzar-e-Hijri, Karachi, Pakistan
| | - Nahitun Naher
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Aravind Raj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Sana Ahmed
- School of Public Health, Dow University of Health Sciences, Gulzar-e-Hijri, Karachi, Pakistan
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW, Australia
| | - Alayne Adams
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
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3
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Harkare HV, Osetinsky B, Ginindza N, Cindzi BT, Mncina N, Akomolafe B, Marowa LR, Ntshalintshali N, Tediosi F. Human and financial resource needs for universal access to WHO-PEN interventions for diabetes and hypertension care in Eswatini: results from a time-and-motion and bottom-up costing study. HUMAN RESOURCES FOR HEALTH 2024; 22:32. [PMID: 38802811 PMCID: PMC11131333 DOI: 10.1186/s12960-024-00913-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Eswatini faces persistent challenges in providing care for diabetes and hypertension, exacerbated by a shortage of healthcare workers. The implementation of WHO-PEN interventions aimed to address these issues, yet their effects on healthcare worker time requirements and associated costs remain unclear. METHODS This study employed a time-and-motion analysis and a bottom-up cost assessment to quantify the human and financial resources required for scaling up WHO-PEN interventions nationally in Eswatini for all estimated diabetic and hypertensive patients. RESULTS Findings reveal that healthcare workers in intervention-arm clinics reported longer workday durations compared to those in control-arm clinics, yet spent less time per patient while seeing more patients. The implementation of WHO-PEN interventions increased the workload on healthcare workers but also led to a notable increase in patient care utilization. Furthermore, a morning peak in patient visits was identified, suggesting potential opportunities for optimizing patient flow. Notably, scaling up care provision nationally with WHO-PEN interventions proved to be more cost saving than expanding standard-of-care treatment. CONCLUSION WHO-PEN interventions hold promise in improving access to diabetes and hypertension care in Eswatini while offering an efficient solution. However, addressing challenges in healthcare workforce creation and retention is crucial for sustained effectiveness. Policy makers must consider all aspects of the WHO-PEN intervention for informed decision-making. Trial registration US Clinical Trials Registry. NCT04183413. Trial registration date: December 3, 2019. https://ichgcp.net/clinical-trials-registry/NCT04183413.
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Affiliation(s)
- Harsh Vivek Harkare
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Brianna Osetinsky
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Ntombifuthi Ginindza
- Ministry of Health in Eswatini, Ministry of Justice & Constitutional Affairs Building, Mhlambanyatsi Road, Mbabane, Eswatini
| | - Bongekile Thobekile Cindzi
- Clinton Health Access Initiative, Mbhilibhi House, Plot 170, Corner Tsekwane/Mbhilibhi Street, Mbabane, Eswatini
| | - Nomfundo Mncina
- Clinton Health Access Initiative, Mbhilibhi House, Plot 170, Corner Tsekwane/Mbhilibhi Street, Mbabane, Eswatini
| | - Babatunde Akomolafe
- Clinton Health Access Initiative, Mbhilibhi House, Plot 170, Corner Tsekwane/Mbhilibhi Street, Mbabane, Eswatini
| | - Lisa-Rufaro Marowa
- Clinton Health Access Initiative, Mbhilibhi House, Plot 170, Corner Tsekwane/Mbhilibhi Street, Mbabane, Eswatini
| | - Nyasatu Ntshalintshali
- Clinton Health Access Initiative, Mbhilibhi House, Plot 170, Corner Tsekwane/Mbhilibhi Street, Mbabane, Eswatini
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Stein DT, Reitsma MB, Geldsetzer P, Agoudavi K, Aryal KK, Bahendeka S, Brant LCC, Farzadfar F, Gurung MS, Guwatudde D, Houehanou YCN, Malta DC, Martins JS, Saeedi Moghaddam S, Mwangi KJ, Norov B, Sturua L, Zhumadilov Z, Bärnighausen T, Davies JI, Flood D, Marcus ME, Theilmann M, Vollmer S, Manne-Goehler J, Atun R, Sudharsanan N, Verguet S. Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries. Nat Med 2024; 30:414-423. [PMID: 38278990 DOI: 10.1038/s41591-023-02769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/15/2023] [Indexed: 01/28/2024]
Abstract
Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom quintiles under the treatment scenario (29.1 CVD cases averted per 1,000 people living with hypertension in the bottom quintile (Q1) versus 17.2 in the top quintile (Q5)), and the proportion of total CVD cases averted would be largest among the lowest quintiles in upper-middle-income countries under both diagnosis (32.0% of averted cases in Q1 versus 11.9% in Q5) and treatment (29.7% of averted cases in Q1 versus 14.0% in Q5) scenarios. Targeted improvements in hypertension diagnosis and treatment could substantially reduce socioeconomic-based inequalities in CVD burden in low- and middle-income countries.
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Affiliation(s)
- Dorit Talia Stein
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marissa B Reitsma
- Department of Health Policy, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Kokou Agoudavi
- Noncommunicable Disease Program, Ministry of Health, Lomé, Togo
| | - Krishna Kumar Aryal
- Bergen Centre for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Silver Bahendeka
- MKPGMS-Uganda Martyrs University, Kampala, Uganda
- St. Francis Hospital, Nsambya, Kampala, Uganda
| | - Luisa C C Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | | | - Deborah Carvalho Malta
- Department Maternal Child and Public Health, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - João Soares Martins
- Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Díli, Timor-Leste
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Kibachio Joseph Mwangi
- World Health Organization, Pretoria, South Africa
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Bolormaa Norov
- Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Lela Sturua
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | | | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala
| | - Maja E Marcus
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sebastian Vollmer
- Department of Economics & Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Beshah SA, Husain MJ, Dessie GA, Worku A, Negeri MG, Banigbe B, Moran AE, Basu S, Kostova D. Cost analysis of the WHO-HEARTS program for hypertension control and CVD prevention in primary health facilities in Ethiopia. PUBLIC HEALTH IN PRACTICE 2023; 6:100423. [PMID: 37727705 PMCID: PMC10506051 DOI: 10.1016/j.puhip.2023.100423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/13/2023] [Accepted: 08/17/2023] [Indexed: 09/21/2023] Open
Abstract
Background In 2020, Ethiopia launched the Ethiopia Hypertension Control Initiative (EHCI) program to improve hypertension care using the approach described in the WHO HEARTS technical package. Objective To estimate the costs of implementing the HEARTS program for hypertension control and cardiovascular disease (CVD) prevention in the primary care setting in Ethiopia for adult primary care users in the catchment area of five examined facilities. Study design This study entails a program cost analysis using cross-sectional primary and secondary data. Methods Micro-costing facility surveys were used to assess activity costs related to training, counselling, screening, lab diagnosis, medications, monitoring, and start-up costs at five selected health facilities. Cost data were obtained from primary and secondary sources, and expert opinion. Annual costs from the health system perspective were estimated using the Excel-based HEARTS costing tool under two intervention scenarios - hypertension-only control and a CVD risk management program, which addresses diabetes and hypercholesterolemia in addition to hypertension. Results The estimated cost per adult primary care user was USD 5.3 for hypertension control and USD 19.3 for integrated CVD risk management. The estimated medication cost per person treated for hypertension was USD 9.0, whereas treating diabetes and high cholesterol would cost USD 15.4 and USD 15.3 per person treated, respectively. Medications were the major cost driver, accounting for 37% of the total cost in the hypertension control program. In the CVD risk management scenario, the proportions of medication and lab diagnostics of total costs were 18% and 64%, respectively. Conclusions The results from this study can inform planning and budgeting for HEARTS scale-up to prevent CVD across Ethiopia.
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Affiliation(s)
| | - Muhammad Jami Husain
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | | | | | - Andrew E. Moran
- Resolve to Save Lives, New York, USA
- Columbia University Irving Medical Center, New York, USA
| | - Soumava Basu
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Deliana Kostova
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, USA
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Moran AE, Gupta R. Implementation of Global Hearts Hypertension Control Programs in 32 Low- and Middle-Income Countries: JACC International. J Am Coll Cardiol 2023; 82:1868-1884. [PMID: 37734459 DOI: 10.1016/j.jacc.2023.08.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/23/2023]
Abstract
In 2017, the World Health Organization (WHO) and Resolve to Save Lives partnered with country governments and other stakeholders to design, test, and scale up the WHO HEARTS hypertension services package in 32 low- and middle-income countries. Facility-based HEARTS performance indicators included number of patients enrolled, number treated and with blood pressure controlled, number who missed a scheduled follow-up visit, and number lost to follow-up. By 2022, HEARTS hypertension control programs treated 12.2 million patients in 165,000 primary care facilities. Hypertension control was 38% (median 48%; range 5%-86%). In 4 HEARTS countries using the same digital health information system, facility-based control improved from 18% at baseline to 46% in 48 months. At the population level, median estimated population-based hypertension control was 11.0% of all hypertension patients (range 2.0%-34.7%). The Global Hearts experience of implementing WHO HEARTS demonstrates the feasibility of controlling hypertension in low- and middle-income country primary care settings.
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Affiliation(s)
- Andrew E Moran
- Resolve to Save Lives, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA.
| | - Reena Gupta
- Resolve to Save Lives, New York, New York, USA; University of California-San Francisco, San Francisco, California, USA
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Sahoo SK, Pathni AK, Krishna A, Sharma B, Cazabon D, Moran AE, Hering D. Financial implications of protocol-based hypertension treatment: an insight into medication costs in public and private health sectors in India. J Hum Hypertens 2023; 37:828-834. [PMID: 36271130 PMCID: PMC10471490 DOI: 10.1038/s41371-022-00766-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/20/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022]
Abstract
Hypertension is a major public health challenge in low- and middle-income countries (LMICs) and calls for large-scale effective hypertension control programs. Adoption of drug and dose-specific treatment protocols recommended by the World Health Organization-HEARTS Initiative is key for hypertension control programs in LMICs. We estimated the annual medication cost per patient using three such protocols (protocol-1 and protocol-2 with Amlodipine, Telmisartan, using add-on doses and different drug orders, adding Chlorthalidone; protocol-3 with a single-pill combination (SPC) of Amlodipine/Telmisartan with dose up-titration, and addition of Chlorthalidone, if required) in India. The medication cost was simulated with different hypertension control assumptions for each protocol and calculated based on prices in the public and private sectors in India. The estimated annual medication cost per patient for protocol-1 and protocol-2 was $33.88-58.44 and $51.57-68.83 for protocol-3 in the private sector. The medication cost was lower in the generic stores ($5.78-9.57 for protocol-1 and protocol-2, and $7.35-9.89 for protocol-3). The medication cost for patients was the lowest ($2.05-3.89 for protocol-1 and protocol-2, and $2.94-3.98 for protocol-3) in the public sector. At less than $4 per patient per annum, scaling up a hypertension control program with specific treatment protocols is a potentially cost-effective public health intervention. Expanding low-cost generic retail networks would extend affordability in the private sector. The cost of treatment with SPC is comparable with non-SPC protocols and can be adopted in a public health program considering the advantage of simplified logistics, reduced pill burden, improved treatment adherence, and blood pressure control.
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Affiliation(s)
| | | | | | | | | | - Andrew E Moran
- Resolve to Save Lives, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland.
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Khan T, Moran AE, Perel P, Whelton PK, Brainin M, Feigin V, Kostova D, Richter P, Ordunez P, Hennis A, Lackland DT, Slama S, Pineiro D, Martins S, Williams B, Hofstra L, Garg R, Mikkelsen B. The HEARTS partner forum-supporting implementation of HEARTS to treat and control hypertension. Front Public Health 2023; 11:1146441. [PMID: 37554732 PMCID: PMC10405076 DOI: 10.3389/fpubh.2023.1146441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
Cardiovascular diseases (CVD), principally ischemic heart disease (IHD) and stroke, are the leading causes of death (18. 6 million deaths annually) and disability (393 million disability-adjusted life-years lost annually), worldwide. High blood pressure is the most important preventable risk factor for CVD and deaths, worldwide (10.8 million deaths annually). In 2016, the World Health Organization (WHO) and the United States Centers for Disease Control (CDC) launched the Global Hearts initiative to support governments in their quest to prevent and control CVD. HEARTS is the core technical package of the initiative and takes a public health approach to treating hypertension and other CVD risk factors at the primary health care level. The HEARTS Partner Forum, led by WHO, brings together the following 11 partner organizations: American Heart Association (AHA), Center for Chronic Disease Control (CCDC), International Society of Hypertension (ISH), International Society of Nephrology (ISN), Pan American Health Organization (PAHO), Resolve to Save Lives (RTSL), US CDC, World Hypertension League (WHL), World Heart Federation (WHF) and World Stroke Organization (WSO). The partners support countries in their implementation of the HEARTS technical package in various ways, including providing technical expertise, catalytic funding, capacity building and evidence generation and dissemination. HEARTS has demonstrated the feasibility and acceptability of a public health approach, with more than seven million people already on treatment for hypertension using a simple, algorithmic HEARTS approach. Additionally, HEARTS has demonstrated the feasibility of using hypertension as a pathfinder to universal health coverage and should be a key intervention of all basic benefit packages. The partner forum continues to find ways to expand support and reinvigorate enthusiasm and attention on preventing CVD. Proposed future HEARTS Partner Forum activities are related to more concrete information sharing between partners and among countries, expanded areas of partner synergy, support for implementation, capacity building, and advocacy with country ministries of health, professional societies, academy and civil societies organizations. Advancing toward the shared goals of the HEARTS partners will require a more formal, structured approach to the forum and include goals, targets and published reports. In this way, the HEARTS Partner Forum will mirror successful global partnerships on communicable diseases and assist countries in reducing CVD mortality and achieving global sustainable development goals (SDGs).
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Affiliation(s)
- Taskeen Khan
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - Andrew E. Moran
- Resolve to Save Lives, New York, NY, United States
- Department of Medicine, Columbia University, New York, NY, United States
| | - Pablo Perel
- Centre for Global Chronic Conditions, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- World Heart Federation, Geneva, Switzerland
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
- World Hypertension League, New Orleans, LA, United States
| | - Michael Brainin
- Department of Clinical Neurology, Danube University, Krems, Austria
- World Stroke Organization, Geneva, Switzerland
| | - Valery Feigin
- World Stroke Organization, Geneva, Switzerland
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Deliana Kostova
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Non-communicable Diseases and Mental Health, Atlanta, GA, United States
| | - Patricia Richter
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Non-communicable Diseases and Mental Health, Atlanta, GA, United States
| | - Pedro Ordunez
- Pan American Health Organization/World Health Organization, Washington, DC, United States
| | - Anselm Hennis
- Pan American Health Organization/World Health Organization, Washington, DC, United States
| | - Daniel T. Lackland
- World Hypertension League, New Orleans, LA, United States
- Division of Translational Neurosciences and Population Studies, Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Slim Slama
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - Daniel Pineiro
- World Heart Federation, Geneva, Switzerland
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Sheila Martins
- World Stroke Organization, Geneva, Switzerland
- Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bryan Williams
- International Society of Hypertension, Essex, United Kingdom
| | - Leonard Hofstra
- Amsterdam UMC—Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Renu Garg
- Resolve to Save Lives, New York, NY, United States
| | - Bente Mikkelsen
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
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Moran AE, Farrell M, Cazabon D, Sahoo SK, Mugrditchian D, Pidugu A, Chivardi C, Walbaum M, Alemayehu S, Isaranuwatchai W, Ankurawaranon C, Choudhury SR, Pickersgill SJ, Watkins DA, Husain MJ, Rao KD, Matsushita K, Marklund M, Hutchinson B, Nugent R, Kostova D, Garg R. Building the health-economic case for scaling up the WHO-HEARTS hypertension control package in low- and middle-income countries. Rev Panam Salud Publica 2022; 46:e140. [PMID: 36071923 PMCID: PMC9440739 DOI: 10.26633/rpsp.2022.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
ABSTRACT
Generally, hypertension control programs are cost-effective, including in low- and middle-income countries, but country governments and civil society are not likely to support hypertension control programs unless value is demonstrated in terms of public health benefits, budget impact, and value-for-investment for the individual country context. The World Health Organization (WHO) and the Pan American Health Organization (PAHO) established a standard, simplified Global HEARTS approach to hypertension control, including preferred antihypertensive medicines and blood pressure measurement devices. The objective of this study is to report on health economic studies of HEARTS hypertension control package cost (especially medication costs), cost-effectiveness, and budget impact and describe mathematical models designed to translate hypertension control program data into the optimal approach to hypertension care service delivery and financing, especially in low- and middle-income countries. Early results suggest that HEARTS hypertension control interventions are either cost-saving or cost-effective, that the HEARTS package is affordable at between US$ 18-44 per person treated per year, and that antihypertensive medicines could be priced low enough to reach a global standard of an average <US$ 5 per patient per year in the public sector. This health economic evidence will make a compelling case for government ownership and financial support for national scale hypertension control programs.
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Affiliation(s)
- Andrew E. Moran
- Resolve to Save Lives, New York, United States of America
- Columbia University Irving Medical Center, New York, United States of America
| | | | | | | | | | - Anirudh Pidugu
- Columbia University Irving Medical Center, New York, United States of America
| | - Carlos Chivardi
- Center for Health Economics, University of York, York, United Kingdom
| | | | | | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health of Thailand, Bangkok, Thailand
| | | | | | | | | | - Muhammad Jami Husain
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Krishna D. Rao
- Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Matti Marklund
- Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Brian Hutchinson
- Center for Global Noncommunicable Diseases, RTI International, Seattle, United States of America
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Seattle, United States of America
| | - Deliana Kostova
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Renu Garg
- Resolve to Save Lives, New York, United States of America
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