Community-based care models for arterial hypertension management in non-pregnant adults in sub-Saharan Africa: a literature scoping review and framework for designing chronic services

Abstract

Background Arterial hypertension (aHT) is the leading cardiovascular disease (CVD) risk factor in sub-Saharan Africa; it remains, however, underdiagnosed, and undertreated. Community-based care services could potentially expand access to aHT diagnosis and treatment in underserved communities. In this scoping review, we catalogued, described, and appraised community-based care models for aHT in sub-Saharan Africa, considering their acceptability, engagement in care and clinical outcomes. Additionally, we developed a framework to design and describe service delivery models for long-term aHT care. Methods We searched relevant references in Embase Elsevier, MEDLINE Ovid, CINAHL EBSCOhost and Scopus. Included studies described models where substantial care occurred outside a formal health facility and reported on acceptability, blood pressure (BP) control, engagement in care, or end-organ damage. We summarized the interventions’ characteristics, effectiveness, and evaluated the quality of included studies. Considering the common integrating elements of aHT care services, we conceptualized a general framework to guide the design of service models for aHT. Results We identified 18,695 records, screened 4,954 and included twelve studies. Four types of aHT care models were identified: services provided at community pharmacies, out-of-facility, household services, and aHT treatment groups. Two studies reported on acceptability, eleven on BP control, ten on engagement in care and one on end-organ damage. Most studies reported significant reductions in BP values and improved access to comprehensive CVDs services through task-sharing. Major reported shortcomings included high attrition rates and their nature as parallel, non-integrated models of care. The overall quality of the studies was low, with high risk of bias, and most of the studies did not include comparisons with routine facility-based care. Conclusions The overall quality of available evidence on community-based aHT care is low. Published models of care are very heterogeneous and available evidence is insufficient to recommend or refute further scale up in sub-Sahara Africa. We propose that future projects and studies implementing and assessing community-based models for aHT care are designed and described according to six building blocks: providers, target groups, components, location, time of service delivery, and their use of information systems.

Community-based management of arterial hypertension and cardiovascular risk factors by lay village health workers for people with controlled and uncontrolled blood pressure in rural Lesotho: Joint protocol for two cluster-randomized trials within the ComBaCaL cohort study (ComBaCaL aHT Twic 1 & ComBaCaL aHT TwiC 2)

“…(61). According to a recent scoping review, our two TwiCs will be the rst to assess a multifaceted, communitybased, VHW-led aHT care intervention including pharmacological treatment in Africa (24).…”

Innovative Remote Management Solutions for the Control of Hypertension

“…These programs have grown in part from models built for the treatment of HIV and tuberculosis. 64 All offered different elements of task shifting or The market landscape for hypertension remote monitoring companies and programs is large and complex, comprising an array of comprehensive programs, services, products, and devices. Provided by: Manatt Health, November 3, 2022.…”

“…These programs have grown in part from models built for the treatment of HIV and tuberculosis. 64 All offered different elements of task shifting or task sharing, but doctors played a substantial role in the majority. Although most reported significant reductions in BP, studies were marked by high attrition rates and high risk of bias; work is urgently needed to assess optimal future care models in these settings.…”

Community-based models of care for management of type 2 diabetes mellitus among non-pregnant adults in sub-Saharan Africa: a scoping review

“…Another systematic review and meta-analysis on the effect of community-based programs on diabetes prevention in low- and middle-income countries 1 revealed that such programs had positive outcomes on patients at risk of T2DM. A recent scoping review indicates substantial potential of community-based care models for arterial hypertension in SSA 21 . Moving care of uncomplicated cases and low-risk groups to the community level and to non-physician health workers who are themselves supervised by higher health cadres, has advantages including fewer clinic visits, not having to travel long distances, not waiting in queues, and freeing up medical services in the facility for complicated cases and high-risk groups.…”