Blood from a stone: funding hypertension prevention, treatment, and care in low- and middle-income countries

Cohn, Jennifer; Kostova, Deliana; Moran, Andrew E.; Cobb, Laura K.; Pathni, Anupam Khungar; Bisrat, Dawit

doi:10.1038/s41371-021-00583-8

Cited by 9 publications

(11 citation statements)

References 29 publications

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“…Several reasons account for the problem of uncontrolled hypertension in SSA. 42 - 49 These include inadequate access to healthcare facilities and lack of affordable antihypertensive medications in situations where patients are supposed to purchase the medications themselves to treat an asymptomatic condition such as hypertension. 42 - 49 .…”

Section: Discussionmentioning

confidence: 99%

Association Between Alcohol Consumption and Blood Pressure Levels Among HIV Sero-Positive and Sero-Negative Cohorts: A Secondary Analysis of the Vukuzazzi Study

Wireko,

Hendricks,

Bedu-Addo

et al. 2024

J Prim Care Community Health

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Background: The effect of hypertension is aggravated by lifestyle factors such as alcohol consumption. This study sought to determine the association between alcohol consumption and the level of blood pressures among HIV seronegative and seropositive cohorts. Methods: This secondary analysis was performed on a cross-sectional survey data of 17 922 participants during the period between 2018 and 2020. A questionnaire was used to obtain participants’ alcohol consumption history, which was categorized into non-alcohol consumers, non-heavy alcohol consumers, and heavy alcohol consumers. A linear regression model was used to establish relationships among participants with raised blood pressure (BP ≥ 140/90 mmHg). Results: Out of the total participants, 3553 (19.82%) were hypertensives. Almost 13% of the hypertensives (n = 458; 12.89%) were undiagnosed, and 12.44 % (442) had uncontrolled hypertension. About 14.52% of the hypertensives (3553) were not on any antihypertensive medication. Male non-consumers of alcohol had the highest systolic and diastolic BP; uncontrolled systolic BP (165.53 ± 20.87 mmHg), uncontrolled diastolic BP (102.28 ± 19.21mmHg). Adjusted for covariates, moderate alcohol consumption was associated with HTN among participants who were HIV seropositive [unadjusted (RR = 1.772, P = .006, 95% CI (1.178-2.665)], [RR = 1.772, P = .005, 95% CI (1.187-2.64)]. [unadjusted RR = 1.876, P = .036, 95% CI (1.043-3.378)], adjusted RR = 1.876, P = .041, 95% CI (1.024-3.437). Both moderate and heavy alcohol consumption were significantly related to hypertension among HIV sero-negative [unadjusted model, moderate consumption RR = 1.534 P = .003, 95% CI (1.152-2.044)], [adjusted model, moderate alcohol consumption RR = 1.535, P = .006, 95% CI (1.132-2.080)], [unadjusted model, heavy alcohol consumption, RR = 2.480, P = .030, 95% CI (1.091-5.638)], [adjusted model RR = 2.480, P = .034, 95% CI (1.072-5.738)]. Conclusion: Alcohol consumption is significantly related to increase BP regardless of HIV infection.

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Section: Discussionmentioning

confidence: 99%

Association Between Alcohol Consumption and Blood Pressure Levels Among HIV Sero-Positive and Sero-Negative Cohorts: A Secondary Analysis of the Vukuzazzi Study

Wireko,

Hendricks,

Bedu-Addo

et al. 2024

J Prim Care Community Health

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“…The primary goal of a digital health information system for a chronic disease programme is to function as a support for clinicians and programme managers by providing feedback loops to improve quality. 11 …”

Section: Discussionmentioning

confidence: 99%

“…Providing programme managers with monthly data on these three indicators supports identification of struggling facilities and implementation of programme improvements. The primary goal of a digital health information system for a chronic disease programme is to function as a support for clinicians and programme managers by providing feedback loops to improve quality 11…”

Section: Discussionmentioning

confidence: 99%

Keep it simple: designing a user-centred digital information system to support chronic disease management in low/middle-income countries

Burka¹,

Gupta

Moran

et al. 2023

BMJ Health Care Inform

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Objective Implement a user-centred digital health information system to facilitate rapidly and substantially increasing the number of patients treated for hypertension in low/middle-income countries. Methods User-centred design of Simple, an offline-first app for mobile devices to record patient clinical visits and a web-based dashboard to monitor programme performance. Results The Simple mobile application scaled rapidly over the past 4 years to reach more than 11 400 primary care facilities in four countries with over 3 million patients enrolled. Simple achieved median duration for new patient registration of 76 s (IQR 2 s) and follow-up visit entry of 13 s (IQR 1 s). Conclusions A fast, easy-to-use digital information system for hypertension programmes that accommodates healthcare worker time constraints by minimising data entry and focusing on key performance indicators can successfully reach scale in low-resource settings.

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“…Fortunately, the adoption of SAANE algorithms can enable the implementation of effective interventions to address these barriers. While additional investments will be required to scale up hypertension programs, SAANE algorithms and the models of care they enable can reduce the budget needed to scale up hypertension care in several areas, including medication prices, laboratory monitoring costs, and health system expenditures [ 18 ].…”

Section: The Current Situation For Global Hypertension Treatmentmentioning

confidence: 99%

“…International and national hypertension guidelines are complex, involving multiple steps to initiate treatment, increase medication dose and add additional drug classes to achieve hypertension control. In 2018, the WHO published the HEARTS technical package [ 18 ], which provided nine possible algorithms that national programmes could consider for adoption. These algorithms indicate clear titration steps but do not go as far as selecting a preferred algorithm or naming the preferred drug within a class.…”

Section: Why Simple Treatment Algorithms Are Needed By the Health Systemmentioning

confidence: 99%

Addressing Failures in Achieving Hypertension Control in Low- and Middle-Income Settings through Simplified Treatment Algorithms

Cohn¹,

Bygrave

Roberts

et al. 2022

Global Heart

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Hypertension is the most important risk factor for cardiovascular diseases (CVDs), which are the leading global cause of death. Hypertension is under-diagnosed and under-treated in most low- and middle-income countries (LMICs). Current algorithms for hypertension treatment are complex for the healthcare worker, limit decentralization, complicate procurement and often translate to a large pill burden for the person with hypertension. We summarize evidence supporting implementation of simple, algorithmic, accessible, non-toxic and effective (SAANE) algorithms to provide a feasible way to access and maintain quality care for hypertension. Implementation of these algorithms will enable task shifting to less specialised health care workers and lay cadres, provision of fixed dose combinations, consolidation of the market while retaining generic competition, simplification of laboratory requirements, and lowering costs for health systems and people who incur out of pocket expenses.

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Blood from a stone: funding hypertension prevention, treatment, and care in low- and middle-income countries

Cited by 9 publications

References 29 publications

Association Between Alcohol Consumption and Blood Pressure Levels Among HIV Sero-Positive and Sero-Negative Cohorts: A Secondary Analysis of the Vukuzazzi Study

Association Between Alcohol Consumption and Blood Pressure Levels Among HIV Sero-Positive and Sero-Negative Cohorts: A Secondary Analysis of the Vukuzazzi Study

Keep it simple: designing a user-centred digital information system to support chronic disease management in low/middle-income countries

Addressing Failures in Achieving Hypertension Control in Low- and Middle-Income Settings through Simplified Treatment Algorithms

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