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Hypertension is the leading single preventable risk factor for cardiovascular disease. The India Hypertension Control Initiative (IHCI) project was designed to improve hypertension control in public sector clinics. The project was launched in 2018–2019 in 26 districts across five states: Punjab (5), Madhya Pradesh (3), Kerala (4), Maharashtra (4), and Telangana (10), with five core strategies: standard treatment protocol, reliable supply of free antihypertensive drugs, team-based care, patient-centered care, and an information system to track individual patient treatment and blood pressure control. All states implemented simple treatment protocols with three drugs: a long-acting dihydropyridine calcium channel blocker (amlodipine), angiotensin receptor blocker (telmisartan), and thiazide or a thiazide-like diuretic (hydrochlorothiazide or chlorthalidone). Medication supplies were adequate to support at least one month of treatment. Overall, 570,365 hypertensives were enrolled in 2018–2019; 11% did not have follow-up visits in the most recent 12 months. Clinic-level blood pressure control averaged 43% (range 22–79%) by Jan-March, 2020. The proportion of the estimated people with hypertension who had it controlled and documented in public clinics increased three-fold, albeit from very low levels (1.4–5.0%). The IHCI demonstrated the feasibility of implementing protocol-based hypertension treatment and control supported by a reliable drug supply and accurate information systems at scale in Indian primary health care facilities. Lessons from the IHCI’s initial phase will inform plans to improve screening in health care facilities, increase retention in care, and ensure a sustained supply of drugs as part of a nationwide hypertension control program.

Hydatid disease is a zoonotic infection caused by larval stages of dog tapeworms belonging to the genus Echinococcus (family taeniidae) and is also referred to as echinococcosis. Human cystic echinococcosis caused by E. granulosus is the most common presentation and probably accounts for more than 95% of the estimated 2-3 million annual worldwide cases. The liver (70–80%) and lungs (15–25%) are the most frequent locations for echinococcal cysts. The diagnosis is made through the combined assessment of clinical, radiological, and laboratory findings. The treatment is mainly surgical, and, with appropriate diagnosis and treatment, prognosis is good. With advances and increasing experience in laparoscopic surgery, many more attempts have been made to offer the advantage of such a procedure to these patients (Chowbey et al. (2003)).

The India Hypertension Control Initiative (IHCI) has been implemented in public health facilities. This study assessed the perspective of private physicians (PPs) on adopting the core strategies of the IHCI in Bhopal district of Madhya Pradesh. A semi‐structured interview was purposely applied to 30 PPs to obtain their opinions on standardized hypertension treatment protocols, patient‐centered services, and easy‐to‐use information system in their private practices. Verbatim data were recorded and analyzed thematically. Only 11 PPs followed the state hypertension treatment protocol. Among the remaining 19 PPs, the major reasons for not adopting protocol were (1) limited availability of single component hypertension drugs, (2) preferences for fixed dose combinations (FDCs), and (3) fear of either losing patients due to a lack of immediate blood pressure control or causing drug‐related adverse effects. None of the interviewed doctors had resources to provide patient‐centered care and use a digital health information system. Overall, the interviewed doctors identified that free supply of hypertension treatment protocol drugs, inclusion of FDCs in treatment protocol, increasing number of staff for follow‐up visits, and patient education, IT‐based solutions for patient records, employee incentives, and need for national data sharing policies are the key actions to accelerate the adoption of IHCI strategies in the private sector. This exploratory qualitative study suggests that engagement of private sector in the IHCI is feasible. Plans to expand the IHCI to the private sector should consider ensuring the wider availability of hypertension treatment protocol drugs and developing a simple user‐friendly digital platform for patient monitoring.

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.

Low density of formal care providers in rural India results in restricted and delayed access to standardized management of hypertension. Task-sharing with pharmacies, typically the first point of contact for rural populations, can bridge the gap in access to formal care and improve health outcomes. In this study, we implemented a hypertension care program involving task-sharing with twenty private pharmacies between November 2020 and April 2021 in two blocks of Bihar, India. Pharmacists conducted free hypertension screening, and a trained physician offered free consultations at the pharmacy. We calculated the number of subjects screened, initiated on treatment (enrolled) and the change in blood pressure using the data collected through the program application. Of the 3403 subjects screened at pharmacies, 1415 either reported having a history of hypertension or had elevated blood pressure during screening. Of these, 371 (26.22%) were enrolled in the program. Of these, 129 (34.8%) made at least one follow-up visit. For these subjects, the adjusted average difference in systolic and diastolic blood pressure between the screening and follow-up visits was −11.53 (−16.95 to −6.11, 95% CI) and −4.68 (−8.53 to −0.82, 95% CI) mmHg, respectively. The adjusted odds of blood pressure being under control in this group during follow-up visits compared to screening visit was 7.07 (1.29 to 12.85, 95% CI). Task-sharing with private pharmacies can lead to early detection and improved control of blood pressure in a resource-constrained setting. Additional strategies to increase patient screening and retention rates are needed to ensure sustained health benefits.

Introduction India is facing a shortage of staff nurses; thus, a better understanding of nurses’ workloads is essential for improving and implementing noncommunicable disease (NCD) control strategies. We estimated the proportion of time spent by staff nurses on hypertension and other NCD activities in primary care facilities in 2 states in India. Methods We conducted a cross-sectional study in 6 purposively selected primary care facilities in Punjab and Madhya Pradesh during July through September 2021. We used a standardized stopwatch to collect data for time spent on direct hypertension activities (measuring blood pressure, counseling, recording blood pressure measurement, and other NCD-related activities), indirect hypertension activities (data management, patient follow-up calls), and non-NCD activities. We used the Mann-Whitney U test to compare the median time spent on activities between facilities using paper-based records and the Simple mobile device–based app (open-source software). Results Six staff nurses were observed for 213 person-hours. Nurses spent 111 person-hours (52%; 95% CI, 45%–59%) on direct hypertension activities and 30 person-hours (14%; 95% CI, 10%–19%) on indirect hypertension activities. The time spent on blood pressure measurement (34 minutes) and documentation (35 minutes) was the maximum time on any given day. Facilities that used paper records spent more median time (39 [IQR, 26–62] minutes) for indirect hypertension activities than those using the Simple app (15 [IQR, 11–19] minutes; P < .001). Conclusion Our study found that hypertension activities required more than half of nurses’ time in India’s primary care facilities. Digital systems can help to reduce the time spent on indirect hypertension activities.

Background: Most patients with hypertension in India are not treated, in part due to insufficient healthcare providers. Objective: Estimate the current hypertension treatment capacity of the public healthcare system in India and simulate the effects of workforce system and treatment reforms designed to increase coverage of hypertension treatment. Methods: We estimated the hypertension treatment capacity and salary costs of public healthcare facilities (subcenters, primary and community healthcare centers) under different assumptions on workforce size, task sharing, and treatment frequencies. Results: In 2020, an estimated 9% of all hypertensives in India (~23 million adults) are being treated for hypertension in subcenters and primary/community healthcare centers. Treating 30% of hypertensives without task sharing would require an additional >400,000 staff and >340 billion INR/year in salaries ( Figure ). Task sharing under current legislation was estimated to allow the current workforce to treat 14%, while a feasible extension of task sharing beyond the current legislation (e.g., allowing nurses to prescribe medicines) could treat 57% of hypertensive adults with the same workforce. Applying quarterly visits in addition to the extended task sharing, the current workforce could treat all hypertensives adults in India. Conclusion: Under the current practice, even modest increases of hypertension treatment coverage will require substantial additional human and financial resources. Extended task sharing plus fewer visits with longer prescription period may achieve nationwide hypertension treatment at public systems without additional workforce.