The Effectiveness of Community Health Workers for CVD Prevention in LMIC

Abstract

Community health workers (CHW) may be effective in tackling the burden of cardiovascular diseases in low- and middle-income countries (LMIC). This review examines whether CHWs can improve the identification and control of cardiovascular risk factors in LMIC. We searched for studies that used CHW as a basis for cardiovascular risk factor management. Our search yielded 11 articles that targeted cardiovascular risk factor assessment, hypertension, diabetes, smoking, diet and physical activity. There were 4 randomized controlled trials, 3 quasi-experimental studies, 3 cross-sectional studies, and 1 retrospective analysis. Eight studies reported positive results with CHW being able to effectively screen for cardiovascular risk factors, decrease systolic blood pressure, decrease fasting blood glucose, increase quit rates of smoking, decrease weight, and improve diet and physical activity. Our review demonstrates that CHW may be effective in helping tackle the burden of cardiovascular disease in LMIC.

Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation

“…Because the majority of those persons received a linkage appointment, SEARCH correctly referred a total of 7,978 people across the three sites: 82.7% of the proportion with confirmed HTN (Table 2). To our knowledge, although small studies have demonstrated the feasibility of using non-physician workers for HTN control in low-and middle-income countries [14,14,16,17], no population-wide HTN screening initiative on SEARCH's scale has previously been evaluated for care fidelity or outcomes, although these initiatives have become more common in recent years [14,15,16,17,46,47,48]. Moreover, in Eastern and Western Uganda, SEARCH demonstrates that supervised nonphysician providers can provide consistent clinical care for HTN according to established algorithms, and retain patients over time, achieving treatment rates comparable to high-income countries [49].…”

“…Previous work demonstrates community-level programs to screen and treat CVD risk factors in sub-Saharan Africa are efficacious and cost-effective. Most successful models have leveraged nurses, community health workers, and other non-physicians [14,15,16,17]. Recent studies demonstrate that programs for control of HIV can be leveraged for the control of chronic diseases such as HTN [18,19], though quantitative data on care linkage, blood pressure control, and other operational outcomes are scarce [20,21,22].…”

“…These inconsistent findings may be due to incomplete program fidelity: projects designed to screen and treat patients for HTN and CVD are not consistently implemented as intended, precluding accurate assessment of their impact. A recent systematic review found the fidelity of such projects ranged from 16-52%, with highfidelity programs yielding more positive results [15]-demonstrating that fidelity is prerequisite to program efficacy.…”

Prevalence and pattern of cardiovascular risk factors in a population in India

“…They are usually of a similar socioeconomic background as their patients, which may allow more effective attenuation of the asymmetry of information between patients and the world of healthcare 20. A few studies that have targeted individual cardiovascular risk factors using CHWs have shown promising results 21. However, given the multiplicity of risk factors with high prevalence, progress will likely hinge on the ability of CHWs to successfully mitigate multiple cardiovascular risk factors, thus ensuring a cost-effective holistic approach to community cardiovascular health.…”

Beyond Sharing and Shifting: Raising the Bar for Global Rheumatic Heart Disease Control

“…Even within cardiovascular disease, as of 2017, a systematic review of CHWs-driven interventions found "no studies . that looked at combined cardiovascular risk management" as opposed to management of isolated risk factors [12]. And yet, in the case of RHD, natural complementarities with broader cardiovascular disease management abound, such as the use of echocardiography to diagnose and characterize other forms of heart failure, fluid and volume management, and anticoagulation for nonvalvular atrial fibrillation.…”